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Biondo S, Frago R, Kreisler E. Primary tumor resection for asymptomatic colorectal cancer with unresectable metastasis: the end of the dilemma. Ann Oncol 2024; 35:757-759. [PMID: 38969010 DOI: 10.1016/j.annonc.2024.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 06/21/2024] [Indexed: 07/07/2024] Open
Affiliation(s)
- S Biondo
- Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital, and Bellvitge Biomedical Investigation Institute (IDIBELL), Barcelona; Department of Clinical Sciences, University of Barcelona, Barcelona, Spain.
| | - R Frago
- Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital, and Bellvitge Biomedical Investigation Institute (IDIBELL), Barcelona; Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
| | - E Kreisler
- Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital, and Bellvitge Biomedical Investigation Institute (IDIBELL), Barcelona; Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
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van der Kruijssen DEW, Elias SG, van de Ven PM, van Rooijen KL, Lam-Boer J', Mol L, Punt CJA, Sommeijer DW, Tanis PJ, Nielsen JD, Yilmaz MK, van Riel JMGH, Wasowiz-Kemps DK, Loosveld OJL, van der Schelling GP, de Groot JWB, van Westreenen HL, Jakobsen HL, Fromm AL, Hamberg P, Verseveld M, Jaensch C, Liposits GI, van Duijvendijk P, Oulad Hadj J, van der Hoeven JAB, Trajkovic M, de Wilt JHW, Koopman M. Upfront resection versus no resection of the primary tumor in patients with synchronous metastatic colorectal cancer: the randomized phase III CAIRO4 study conducted by the Dutch Colorectal Cancer Group and the Danish Colorectal Cancer Group. Ann Oncol 2024; 35:769-779. [PMID: 38852675 DOI: 10.1016/j.annonc.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/11/2024] [Accepted: 06/02/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND Upfront primary tumor resection (PTR) has been associated with longer overall survival (OS) in patients with synchronous unresectable metastatic colorectal cancer (mCRC) in retrospective analyses. The aim of the CAIRO4 study was to investigate whether the addition of upfront PTR to systemic therapy resulted in a survival benefit in patients with synchronous mCRC without severe symptoms of their primary tumor. PATIENTS AND METHODS This randomized phase III trial was conducted in 45 hospitals in The Netherlands and Denmark. Eligibility criteria included previously untreated mCRC, unresectable metastases, and no severe symptoms of the primary tumor. Patients were randomized (1 : 1) to upfront PTR followed by systemic therapy or systemic therapy without upfront PTR. Systemic therapy consisted of first-line fluoropyrimidine-based chemotherapy with bevacizumab in both arms. Primary endpoint was OS in the intention-to-treat population. The study was registered at ClinicalTrials.gov, NCT01606098. RESULTS Between August 2012 and February 2021, 206 patients were randomized. In the intention-to-treat analysis, 204 patients were included (n = 103 without upfront PTR, n = 101 with upfront PTR) of whom 116 were men (57%) with median age of 65 years (interquartile range 59-71 years). Median follow-up was 69.4 months. Median OS in the arm without upfront PTR was 18.3 months (95% confidence interval 16.0-22.2 months) compared with 20.1 months (95% confidence interval 17.0-25.1 months) in the upfront PTR arm (P = 0.32). The number of grade 3-4 events was 71 (72%) in the arm without upfront PTR and 61 (65%) in the upfront PTR arm (P = 0.33). Three deaths (3%) possibly related to treatment were reported in the arm without upfront PTR and four (4%) in the upfront PTR arm. CONCLUSIONS Addition of upfront PTR to palliative systemic therapy in patients with synchronous mCRC without severe symptoms of the primary tumor does not result in a survival benefit. This practice should no longer be considered standard of care.
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Affiliation(s)
- D E W van der Kruijssen
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht
| | - S G Elias
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht
| | - P M van de Ven
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht
| | - K L van Rooijen
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht
| | - J 't Lam-Boer
- Department of Surgery, Radboud University Medical Center, Nijmegen; Department of Surgery, Netherlands Cancer Institute, Amsterdam
| | - L Mol
- Clinical Research Department, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht
| | - C J A Punt
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht
| | - D W Sommeijer
- Department of Medical Oncology, Amsterdam University Medical Center, Amsterdam; Department of Medical Oncology, Flevo Hospital, Almere
| | - P J Tanis
- Department of Surgery, Amsterdam University Medical Center, Amsterdam; Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - J D Nielsen
- Department of Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - M K Yilmaz
- Department of Medical Oncology, Aalborg University Hospital, Aalborg, Denmark
| | - J M G H van Riel
- Department of Medical Oncology, Elisabeth-TweeSteden Hospital, Tilburg
| | | | | | | | - J W B de Groot
- Department of Medical Oncology, Isala Hospital, Zwolle, The Netherlands
| | | | - H L Jakobsen
- Department of Surgery, Herlev and Gentofte Hospital, Herlev, Denmark
| | - A L Fromm
- Department of Medical Oncology, Herlev and Gentofte Hospital, Herlev, Denmark
| | - P Hamberg
- Department of Medical Oncology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - M Verseveld
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - C Jaensch
- Department of Surgery, Regional Hospital Gødstrup, Herning, Denmark
| | - G I Liposits
- Department of Medical Oncology, Regional Hospital Gødstrup, Herning, Denmark
| | | | - J Oulad Hadj
- Department of Medical Oncology, Gelre Hospital, Apeldoorn
| | | | - M Trajkovic
- Department of Medical Oncology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - J H W de Wilt
- Department of Surgery, Radboud University Medical Center, Nijmegen
| | - M Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht.
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Gao Y, Luo Y, Chen W, Xue X, Xiao C, Wei K. Theranostic Nanoplatform Based on Polydopamine-Coated Magnetic Mesoporous Silicon for Precise Cancer Triplex Nanotherapy and Multimodal Imaging. Anal Chem 2024; 96:13557-13565. [PMID: 39115161 DOI: 10.1021/acs.analchem.4c02244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2024]
Abstract
Although targeted therapy has revolutionized oncotherapy, engineering a versatile oncotherapy nanoplatform integrating both diagnostics and therapeutics has always been an intractable challenge to overcome the limitations of monotherapy. Herein, a theranostics platform based on DI/MP-MB has successfully realized the fluorescence detection of disease marker miR-21 and the gene/photothermal/chemo triple synergetic cancer therapy, which can trace the tumor through photothermal and fluorescence dual-mode imaging and overcome the limitations of monotherapy to improve the treatment efficiency of tumors. DI/MP-MB was prepared by magnetic mesoporous silicon nanoparticles (M-MSNs) loaded with doxorubicin (Dox) and new indocyanine green (IR820), and subsequently coating polydopamine as a "gatekeeper", followed by the surface adsorbed with molecular beacons capable of targeting miR-21 for responsive imaging. Under the action of enhanced permeability retention and external magnetic field, DI/MP-MB were targeted and selectively accumulated in the tumor. MiR-21 MB hybridized with miR-21 to form a double strand, which led to the desorption of miR-21 MB from the polydopamine surface and the fluorescence recovery to realize gene silencing and fluorescence imaging for tracking the treatment process. Meanwhile, with the response to the near-infrared irradiation and the tumor's microacid environment, the outer layer polydopamine will decompose, releasing Dox and IR820 to realize chemotherapy and photothermal therapy. Finally, the ability of DI/MP-MB to efficiently suppress tumor growth was comprehensively assessed and validated both in vitro and in vivo. Noteworthily, the excellent anticancer efficiency by the synergistic effect of gene/photothermal/chemo triple therapy of DI/MP-MB makes it an ideal nanoplatform for tumor therapy and imaging.
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Affiliation(s)
- Yuanyuan Gao
- School of Biology and Biological Engineering, South China University of Technology, Guangzhou 510006, P. R. China
| | - Yujia Luo
- School of Biology and Biological Engineering, South China University of Technology, Guangzhou 510006, P. R. China
| | - Wenyu Chen
- School of Biology and Biological Engineering, South China University of Technology, Guangzhou 510006, P. R. China
| | - Xinrui Xue
- School of Biology and Biological Engineering, South China University of Technology, Guangzhou 510006, P. R. China
| | - Chujie Xiao
- School of Biology and Biological Engineering, South China University of Technology, Guangzhou 510006, P. R. China
| | - Kun Wei
- School of Biology and Biological Engineering, South China University of Technology, Guangzhou 510006, P. R. China
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Huang J, Zhou J, Zhang P, Wu Q, Wang Z. Primary tumor resection for asymptomatic colorectal cancer patients with synchronous unresectable metastases: a meta-analysis of randomized controlled trials and case-matched studies. Langenbecks Arch Surg 2024; 409:242. [PMID: 39105876 PMCID: PMC11303460 DOI: 10.1007/s00423-024-03414-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 07/08/2024] [Indexed: 08/07/2024]
Abstract
PURPOSE The value of upfront primary tumor resection (PTR) for asymptomatic unresectable metastatic colorectal cancer (mCRC) patients remains contentious. This meta-analysis aimed to assess the prognostic significance of upfront PTR for asymptomatic unresectable mCRC. METHODS A systematic literature search was performed on June 21st, 2024. To minimize the bias and ensure robust evidence, only randomized controlled trials (RCTs) and case-matched studies (CMS) that compared PTR followed by chemotherapy to chemotherapy alone were included. The primary outcome was overall survival (OS), while cancer-specific survival (CSS) served as the secondary outcome. RESULTS Eight studies (three RCTs and five CMS) involving 1221 patients were included. Compared to chemotherapy alone, upfront PTR followed by chemotherapy did not improve OS (hazard ratios [HR] 0.91, 95% confidence interval [CI] 0.79-1.04, P = 0.17), but was associated with slightly better CSS (HR 0.59, 95% CI 0.40-0.88, P = 0.009). CONCLUSIONS The current limited evidence indicates that upfront PTR does not improve OS but may enhance CSS in asymptomatic unresectable mCRC patients. Ongoing trials are expected to provide more reliable evidence on this issue.
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Affiliation(s)
- Jun Huang
- Colorectal Cancer Center, Department of General Surgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China
- West China Medical School, Sichuan University, Chengdu, 610041, China
| | - Jiahao Zhou
- Colorectal Cancer Center, Department of General Surgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China
- West China Medical School, Sichuan University, Chengdu, 610041, China
| | - Ping Zhang
- Emergency Medicine Department of West China Hospital, Sichuan University, Chengdu, 610041, China
- West China Medical School, Sichuan University, Chengdu, 610041, China
| | - Qingbin Wu
- Colorectal Cancer Center, Department of General Surgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China
| | - Ziqiang Wang
- Colorectal Cancer Center, Department of General Surgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, China.
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Jiang Y, Shao T, Zhao M, Xue Y, Zheng X. A network meta-analysis of efficacy and safety for first-line and maintenance therapies in patients with unresectable colorectal liver metastases. Front Pharmacol 2024; 15:1374136. [PMID: 39130637 PMCID: PMC11310042 DOI: 10.3389/fphar.2024.1374136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 07/01/2024] [Indexed: 08/13/2024] Open
Abstract
Background: Evidence comparing the efficacy of different treatments for patients with unresectable colorectal liver metastases (CRLM) receiving first-line or maintenance therapy is sparse. We aimed to assess the efficacy and safety of these treatments, with a distinct focus on evaluating first-line and maintenance treatments separately. Methods: We conducted Bayesian network meta-analyses, sourcing English-language randomized controlled trials (RCTs) published through July 2023 from databases including PubMed, Embase, the Cochrane Library, ClinicalTrials.gov, and key conference proceedings. Phase Ⅱ or Ⅲ trials that assessed two or more therapeutic regimens were included. Primary outcome was overall survival (OS). Secondary outcomes included progression-free survival (PFS), objective response rate (ORR), adverse events graded as 3 or above (SAE), and R0 liver resection rate. Hazards Ratios (HRs) and 95% confidence intervals (CI) were used as effect size for OS and PFS, Odds Ratios (ORs) and 95% CI were used for ORR, SAEs and R0 resection rate. Subgroup and sensitive analyses were conducted to analysis the model uncertainty (PROSPERO: CRD42023420498). Results: 56 RCTs were included (50 for first-line treatment, six for maintenance therapies), with a total of 21,323 patients. Regarding first-line, for OS, the top three mechanisms were: local treatment + single-drug chemotherapy (SingleCT), Targeted therapy (TAR)+SingleCT, and TAR + multi-drug chemotherapy (MultiCT). Resection or ablation (R/A)+SingleCT, S1, and Cetuximab + intensified fluorouracil-based combination chemotherapy (ICTFU) were identified as the best treatments. For PFS, the top three mechanisms were: Immune therapy + TAR + MultiCT, multi-targeted therapy (MultiTAR), TAR + SingleCT. The top three treatments were: Atezolizumab + Bevacizumab + fluorouracil-based combination chemotherapy (CTFU), TAS-102+bevacizumab, Bevacizumab + ICTFU. Cetuximab + CTFU was the best choice for RAS/RAF wild-type patients. Regarding maintenance treatment, Bevacizumab + SingleCT and Adavosertib were the best options for OS and PFS, respectively. For safety, MultiCT was the safest, followed by local treatment + MultiCT, TAR + MultiCT caused the most SAEs. Bevacizumab plus chemotherapy was found to be the safest among all targeted combination therapies. Conclusion: In first-line, local treatment or targeted therapsy plus chemotherapy are the best mechanisms. R/A + SingleCT or CTFU performed the best for OS, Atezolizumab + Bevacizumab + ICTFU was the best option regarding PFS. For RAS/RAF wild-type patients, Cetuximab + CTFU was the optimal option. Monotherapy may be preferred choice for maintenance treatment. Combination therapy resulted in more SAEs when compared to standard chemotherapy.
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Affiliation(s)
- Yunlin Jiang
- Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, China
- Graduate School of Nanjing University of Chinese Medicine, Nanjing, China
| | - Taihang Shao
- Department of Pharmacoeconomics, School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Mingye Zhao
- Department of Pharmacoeconomics, School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Yahong Xue
- Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, China
| | - Xueping Zheng
- Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, China
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Eng C, Yoshino T, Ruíz-García E, Mostafa N, Cann CG, O'Brian B, Benny A, Perez RO, Cremolini C. Colorectal cancer. Lancet 2024; 404:294-310. [PMID: 38909621 DOI: 10.1016/s0140-6736(24)00360-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/15/2024] [Accepted: 02/21/2024] [Indexed: 06/25/2024]
Abstract
Despite decreased incidence rates in average-age onset patients in high-income economies, colorectal cancer is the third most diagnosed cancer in the world, with increasing rates in emerging economies. Furthermore, early onset colorectal cancer (age ≤50 years) is of increasing concern globally. Over the past decade, research advances have increased biological knowledge, treatment options, and overall survival rates. The increase in life expectancy is attributed to an increase in effective systemic therapy, improved treatment selection, and expanded locoregional surgical options. Ongoing developments are focused on the role of sphincter preservation, precision oncology for molecular alterations, use of circulating tumour DNA, analysis of the gut microbiome, as well as the role of locoregional strategies for colorectal cancer liver metastases. This overview is to provide a general multidisciplinary perspective of clinical advances in colorectal cancer.
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Affiliation(s)
- Cathy Eng
- Division of Hematology and Oncology, Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA.
| | - Takayuki Yoshino
- Department of Gastroenterology and Gastrointestinal Oncology, Cancer Center Hospital East, Kashiwa, Japan
| | - Erika Ruíz-García
- Department of Gastrointestinal Tumors and Translational Medicine Laboratory, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | | | - Christopher G Cann
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Brittany O'Brian
- Division of Hematology and Oncology, Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Amala Benny
- Division of Hematology and Oncology, Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | | | - Chiara Cremolini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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Hu S, Feng J, Fu W, Guo Y. Macrophage Migration Inhibitory Factor (MIF) Upregulates CXCR7 and Contributes to Chemotherapy Resistance in Colorectal Cancer. Cell Biochem Biophys 2024:10.1007/s12013-024-01430-6. [PMID: 39018005 DOI: 10.1007/s12013-024-01430-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2024] [Indexed: 07/18/2024]
Abstract
Colorectal cancer is one of the most common malignant tumors worldwide, with high incidence and mortality rates making it a focus of research. Chemotherapy is a primary treatment modality for colon cancer, but chemotherapy resistance severely impacts treatment efficacy. MIF has been found to promote tumor progression and resistance in various cancers. This study aims to investigate the role of MIF in chemotherapy resistance in colon cancer and its potential mechanisms, particularly through the upregulation of CXCR7 expression, affecting the metabolism and drug sensitivity of colon cancer cells. The expression levels of MIF in colon cancer tissues and its association with patient prognosis were evaluated by analyzing TCGA and HPA data. Subsequently, the expression levels of MIF in colon cancer cell lines and resistant cell lines were detected by qRT-PCR and immunohistochemistry, and the effect of MIF on oxaliplatin sensitivity was assessed. The impact of MIF on the metabolic activity of colon cancer cells was measured using a cellular energy metabolism analyzer. Further experiments explored the mechanism by which MIF affects the metabolic activity of colon cancer cells through the upregulation of CXCR7 expression, and the role of CTCF in regulating CXCR7 transcription was validated by silencing CTCF. Finally, the effect of MIF on drug sensitivity of colon cancer cells was verified in a mouse xenograft tumor model. In this study, we found that the expression of MIF in colon cancer tissues was significantly higher than in normal tissues, and high MIF expression was associated with poor prognosis in patients. The expression levels of MIF in resistant colon cancer cell lines were significantly higher than in parental cell lines, and MIF overexpression significantly increased the resistance of colon cancer cells to oxaliplatin. Conversely, silencing MIF significantly reduced the IC50 value of resistant cells and increased apoptosis. MIF overexpression significantly increased the ECAR and OCR levels of colon cancer cells, while MIF knockdown significantly reduced these metabolic indicators. Further studies indicated that MIF affects the metabolic activity of colon cancer cells by upregulating CXCR7 expression. CTCF binding peaks at the CXCR7 promoter region and luciferase activity assays indicated that CTCF regulates CXCR7 transcription, and silencing CTCF significantly enhanced the sensitivity of colon cancer cells to oxaliplatin. In vivo experiments in mice showed that MIF silencing combined with oxaliplatin treatment significantly inhibited tumor growth and increased the necrotic area of tumor tissues. In conclusion, this study reveals the crucial role of MIF in chemotherapy resistance in colon cancer through the upregulation of CXCR7 expression, with CTCF playing an important regulatory role in this process. Our findings provide new theoretical insights and potential therapeutic targets for overcoming chemotherapy resistance in colon cancer. Future research should further explore the roles of MIF and CXCR7 in other types of cancers and the potential of MIF and CXCR7 as therapeutic targets.
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Affiliation(s)
- Song Hu
- Department of General Surgery, Chongqing University Central Hospital (Chongqing Emergency Medical Center), Chongqing, China
| | - Jiangyi Feng
- Department of General Surgery, Chongqing University Central Hospital (Chongqing Emergency Medical Center), Chongqing, China
| | - Weijie Fu
- Department of General Surgery, Chongqing University Central Hospital (Chongqing Emergency Medical Center), Chongqing, China
| | - Yi Guo
- Department of General Surgery, Chongqing University Central Hospital (Chongqing Emergency Medical Center), Chongqing, China.
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Sekioka A, Ota S, Ito T, Mizukami Y, Tsuboi K, Okamura M, Lee Y, Ishida S, Shim Y, Adachi Y. Long-Term Outcomes of Self-Expandable Metallic Stents as a Bridge to Surgery for Obstructive and Symptomatic Primary Tumors of Stage IV Colorectal Cancer: A Propensity-Score Analysis. J Laparoendosc Adv Surg Tech A 2024; 34:561-567. [PMID: 38574310 DOI: 10.1089/lap.2024.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
Background: Self-expandable metallic stent (SEMS) was introduced for the treatment of obstructive colorectal cancer (CRC) a few decades ago. However, its long-term outcomes remain controversial, especially for stage IV CRC. The aim of this study was to clarify the outcomes of SEMS as a "bridge to surgery" (BTS) for obstructive and symptomatic primary tumors in stage IV CRC by one-to-one propensity-score matching. Materials and Methods: This retrospective cohort study was conducted at a single center from January 2007 to December 2017. Patients with obstructive and symptomatic primary tumors of stage IV CRC underwent primary resection (PR) or placement of a SEMS as a BTS. They were divided into SEMS and PR groups, and their short- and long-term outcomes were compared. Results: In total, 52 patients were reviewed (SEMS group, 21; PR group, 31). Sixteen patients in both groups were matched using propensity scores. Patients in the SEMS group more frequently underwent laparoscopic surgery than those in the PR group (75% versus 19%, P = .004). The two groups showed no significant differences in perioperative and pathological outcomes. The 5-year overall survival was not significantly different between groups (29% versus 20%, P = .53). Conclusions: As a BTS, the use of SEMS for obstructive and symptomatic primary tumors in CRC stage IV can be a comparable option to PR in terms of short- and long-term outcomes, and would be less invasive with respect to surgical procedures.
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Affiliation(s)
- Akinori Sekioka
- Department of Gastroenterological Surgery, Osaka Saiseikai-Noe Hospital, Osaka, Japan
| | - Shuichi Ota
- Department of Gastroenterological Surgery, Osaka Saiseikai-Noe Hospital, Osaka, Japan
| | - Tetsuo Ito
- Department of Gastroenterological Surgery, Osaka Saiseikai-Noe Hospital, Osaka, Japan
| | - Yo Mizukami
- Department of Gastroenterological Surgery, Osaka Saiseikai-Noe Hospital, Osaka, Japan
| | - Kunihiko Tsuboi
- Department of Gastroenterological Surgery, Osaka Saiseikai-Noe Hospital, Osaka, Japan
| | - Masahiko Okamura
- Department of Gastroenterological Surgery, Osaka Saiseikai-Noe Hospital, Osaka, Japan
| | - Yoo Lee
- Department of Gastroenterological Surgery, Osaka Saiseikai-Noe Hospital, Osaka, Japan
| | - Satoshi Ishida
- Department of Gastroenterological Surgery, Osaka Saiseikai-Noe Hospital, Osaka, Japan
| | - Yugang Shim
- Department of Gastroenterological Surgery, Osaka Saiseikai-Noe Hospital, Osaka, Japan
| | - Yukito Adachi
- Department of Gastroenterological Surgery, Osaka Saiseikai-Noe Hospital, Osaka, Japan
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9
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Sijmons JML, Zamaray B, Veld JV, Warps AK, Dekker JWT, Tuynman JB, van Westreenen HL, Consten ECJ, Tanis PJ. Relief of Obstruction in Left-Sided Obstructive Colon Cancer: Nationwide Analysis of Applied Treatment in the Palliative Setting. J Gastrointest Cancer 2024; 55:691-701. [PMID: 38168860 DOI: 10.1007/s12029-023-01010-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND For relief of bowel obstruction in left-sided obstructive colon cancer (LSOCC), a self-expandable metal stent (SEMS) or decompressing stoma (DS) can be placed. In a curative setting, these two strategies have been extensively studied as a bridge to elective resection. Guidelines recommend SEMS as the preferred option in the palliative setting, but adherence in daily practice is unknown. Therefore, this study aimed to gain more insight into patients with LSOCC who received palliative treatment with SEMS or DS at a national level. METHODS A retrospective population-based cohort study was conducted in the Netherlands. Data from the Netherlands Cancer Registry (NCR) on all patients with LSOCC treated with DS or SEMS not followed by resection of the primary tumour between January 1, 2015, and December 31, 2019, were analysed. Type of treatment (DS or SEMS) for different clinical scenarios, was the main outcome of this study, and was also evaluated over the years (2015-2019). RESULTS Palliative treatment with SEMS or DS for LSOCC was performed in 1077 patients, of whom 79.2% had metastatic disease (M1). Patients without metastatic disease (M0) were older (≥ 80 years M0 67.4%, M1 25.3%, P < 0.001), had a worse clinical condition (ASA III 51.4% versus 36.37%, ASA IV-V 13.3% versus 4.0% P < 0.001) and presented with higher tumour stage (cT4 55.4% versus 33.5%, % P < 0.001). DS was performed in 91.5% of the patients and SEMS in 8.5%. The proportion of DS did not significantly differ between patients with M1 and M0 (91.8% vs. 90.2% respectively, P = 0.525). No increase in SEMS application was observed over the years, with a stable overall proportion of DS of 91-92% per year. In the multivariable analyses, ninety-day mortality and overall survival were not significantly different between SEMS and DS. CONCLUSIONS This study revealed that DS was the primary treatment modality for palliative management of LSOCC in the Netherlands between 2015 and 2019, while the guidelines recommended SEMS as preferred treatment. For patients with LSOCC eligible for stenting in the palliative setting, SEMS placement should become more available and accessible as the preferred treatment option, to avoid a stoma in the terminal phase of life.
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Affiliation(s)
- J M L Sijmons
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 Amsterdam, Amsterdam, The Netherlands
- Dutch Institute for Clinical Auditing, Rijsburgerweg 10, Leiden, The Netherlands
- Cancer Center Amsterdam, Treatment and quality of life, De Boelelaan 1118, Amsterdam, The Netherlands
| | - B Zamaray
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Treatment and quality of life, De Boelelaan 1118, Amsterdam, The Netherlands
| | - J V Veld
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - A K Warps
- Department of Surgery, University Medical Centre Groningen, Hanzeplein 1, Groningen, The Netherlands
| | - J W T Dekker
- Department of Surgery, Reinier de Graaf Groep, Reinier de Graafweg 5, Delft, The Netherlands
| | - J B Tuynman
- Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - H L van Westreenen
- Department of Surgery, Isala Hospital, Dokter van Heesweg 2, Zwolle, The Netherlands
| | - E C J Consten
- Department of Surgery, University Medical Centre Groningen, Hanzeplein 1, Groningen, The Netherlands
- Meander Medical Centre, Department of Surgery, Maatweg 3, Amersfoort, The Netherlands
| | - P J Tanis
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9 Amsterdam, Amsterdam, The Netherlands.
- Cancer Center Amsterdam, Treatment and quality of life, De Boelelaan 1118, Amsterdam, The Netherlands.
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC, Doctor Molewaterplein 40, Rotterdam, 3015 GD, the Netherlands.
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10
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Kataoka K, Ouchi A, Suwa Y, Hirano H, Yamaguchi T, Takamizawa Y, Hanaoka M, Iguchi K, Boku S, Nagata K, Koyama T, Shimada Y, Inomata M, Sano Y, Mizusawa J, Hamaguchi T, Takii Y, Tsukamoto S, Takashima A, Kanemitsu Y. Localized colorectal cancer database integrating 4 randomized controlled trials; (JCOG2310A). EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108354. [PMID: 38657376 DOI: 10.1016/j.ejso.2024.108354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/09/2024] [Accepted: 04/16/2024] [Indexed: 04/26/2024]
Abstract
Although phase III randomized controlled trials (RCTs) represent the most robust statistical approach for answering clinical questions, they require massive expenditures in terms of time, labor, and funding. Ancillary and supplementary analyses using RCTs are sometimes conducted as alternative approaches to answering clinical questions, but the available integrated databases of RCTs are limited. In this background, the Colorectal Cancer Study Group (CCSG) of the Japan Clinical Oncology Group (JCOG) established a database of ancillary studies integrating four phase III RCTs (JCOG0212, JCOG0404, JCOG0910 and JCOG1006) conducted by the CCSG to investigate specific clinicopathological factors in pStage II/III colorectal cancer (JCOG2310A). This database will be updated by adding another clinical trial data and accelerating several analyses that are clinically relevant in the management of localized colorectal cancer. This study describes the details of this database and planned and ongoing analyses as an initiative of JCOG cOlorectal Young investigators (JOY).
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Affiliation(s)
- Kozo Kataoka
- Division of Lower GI, Department of Gastroenterological Surgery, Hyogo Medical University, Hyogo, Japan
| | - Akira Ouchi
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
| | - Yusuke Suwa
- Department of Surgery, Gastroenterological Center Yokohama City University Medical Center, Yokohama, Japan
| | - Hidekazu Hirano
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Toshifumi Yamaguchi
- Cancer Chemotherapy Center, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Yasuyuki Takamizawa
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Marie Hanaoka
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kenta Iguchi
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Shogen Boku
- Cancer Treatment Center, Kansai Medical University Hospital, Osaka, Japan
| | - Ken Nagata
- Department of Surgery, National Defense Medical College, Saitama, Japan
| | - Taiji Koyama
- Department of Medical Oncology and Hematology, Kobe University Hospital and Graduate School of Medicine, Hyogo, Japan
| | - Yasuhiro Shimada
- Clinical Oncology Division, Kochi Health Sciences Center, Kochi, Japan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Oita University Hospital, Oita, Japan
| | - Yusuke Sano
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Junki Mizusawa
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Tetsuya Hamaguchi
- Department of Gastroenterological Oncology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Yasumasa Takii
- Department of Surgery, Niigata Cancer Center Hospital, Niigata, Japan
| | - Shunsuke Tsukamoto
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Atsuo Takashima
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yukihide Kanemitsu
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan.
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11
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Ma R, Yuan H, Wang Y, Wang T, Wang J. Risk factors for hemoglobin decline in gastric cancer patients undergoing postoperative chemotherapy: a retrospective analysis. Am J Transl Res 2024; 16:1701-1710. [PMID: 38883365 PMCID: PMC11170587 DOI: 10.62347/cllz7409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 12/06/2023] [Indexed: 06/18/2024]
Abstract
OBJECTIVE To investigate the independent risk factors for a decreased hemoglobin level in gastric cancer patients undergoing adjuvant chemotherapy. METHODS A retrospective study was conducted on 142 gastric cancer patients who received chemotherapy between May 2017 and May 2021 at the Gansu Provincial Cancer Hospital. All patients were subjected to the same regimen of adjuvant chemotherapy combining platinum/taxane and fluorouracil. The correlation between patients' clinicopathological features and the decreased hemoglobin during adjuvant chemotherapy was analyzed. Logistic and LASSO regression analyses were employed to screen for independent risk factors for decreased hemoglobin during adjuvant chemotherapy. RESULTS Univariate analysis revealed that intraoperative bleeding, pre-chemotherapy anemia, and hypoalbuminemia were risk factors for the decreased hemoglobin in patients during adjuvant chemotherapy (all P < 0.05). Both logistic and LASSO regression analyses corroborated these factors as influential factors in the decrease of hemoglobin (P < 0.05). In addition, both logistic and LASSO regression models demonstrated similar performance in this aspect. The nomogram model was subjected to internal validation, resulting in a C-index of 0.712 (0.629-0.796). The calibration curves exhibited satisfactory alignment with the ideal curve. CONCLUSION Intraoperative blood loss, pre-chemotherapy anemia, and hypoalbuminemia are independent risk factors for hemoglobin reduction following chemotherapy. Moreover, both the logistic and LASSO regression models exhibited equivalent performance in this context. These findings bear substantial clinical implications, aiding physicians in the management of anemia in patients undergoing chemotherapy.
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Affiliation(s)
- Ruofei Ma
- Department of Gastric Tumor Surgery, Gansu Provincial Cancer Hospital, Gansu Provincial Academic Institute for Medical Research No. 2 Xiaoxihu East Street, Qilihe District, Lanzhou 730050, Gansu, China
| | - Huqin Yuan
- Department of Gastric Tumor Surgery, Gansu Provincial Cancer Hospital, Gansu Provincial Academic Institute for Medical Research No. 2 Xiaoxihu East Street, Qilihe District, Lanzhou 730050, Gansu, China
| | - Yaling Wang
- Department of Respiratory Oncology, Gansu Provincial Cancer Hospital, Gansu Provincial Academic Institute for Medical Research No. 2 Xiaoxihu East Street, Qilihe District, Lanzhou 730050, Gansu, China
| | - Tao Wang
- Department of Gastric Tumor Surgery, Gansu Provincial Cancer Hospital, Gansu Provincial Academic Institute for Medical Research No. 2 Xiaoxihu East Street, Qilihe District, Lanzhou 730050, Gansu, China
| | - Jijun Wang
- Department of Gastric Tumor Surgery, Gansu Provincial Cancer Hospital, Gansu Provincial Academic Institute for Medical Research No. 2 Xiaoxihu East Street, Qilihe District, Lanzhou 730050, Gansu, China
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12
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Wu CC, Su CC, Lee PT, Chen YH, Hsu CW, Su YC. Comparative effectiveness of primary tumor resection versus chemotherapy in patients with asymptomatic unresectable metastatic colorectal cancer: a retrospective cohort study using the target trial emulation framework. Am J Cancer Res 2024; 14:2172-2186. [PMID: 38859829 PMCID: PMC11162688 DOI: 10.62347/ugxa9515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 04/07/2024] [Indexed: 06/12/2024] Open
Abstract
Patients who undergo primary tumor resection (PTR) reportedly have significantly higher overall survival (OS) than those who do not undergo this procedure. However, this result is only evident in past retrospective studies, and clinical trial results did not show the same trend. Thus, it remains unclear whether primary tumor resection effectively increases survival in patients with metastatic colorectal cancer (mCRC) across different study designs. We compared the OS of patients with asymptomatic unresectable mCRC who underwent PTR with that of those who did not. This retrospective cohort study was designed to be a target trial emulation of a randomized controlled trial (RCT) that would have compared the effectiveness of PTR versus non-PTR in patients with asymptomatic unresectable mCRC from 2009 to 2017. A systematic review and meta-analysis were conducted to compare the efficacy of PTR and non-PTR in patients with mCRC, and corresponding results were compared. This cohort included 1,132 patients for a per-protocol analysis. The PTR group had non-significantly longer survival (adjusted hazard ratio: 0.70, 95% confidence interval: 0.62-1.01) than the non-PTR group in our cohort. A meta-analysis including five RCTs (1,016 patients) and our cohort found that the PTR group did not have a significantly lower mortality rate than the non-PTR group. The results of this cohort study and previous RCTs suggest that PTR is not associated with improved survival compared to systemic chemotherapy combined with targeted therapy among asymptomatic unresectable mCRC patients. Therefore, routine PTR is not recommended in these patients.
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Affiliation(s)
- Chih-Chien Wu
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Veterans General HospitalKaohsiung 81362, Taiwan
- Department of Surgery, School of Medicine, National Yang Ming Chiao Tung UniversityTaipei 11221, Taiwan
| | - Chien-Chou Su
- Clinical Innovation and Research Center, National Cheng Kung University Hospital, National Cheng Kung UniversityTainan 70403, Taiwan
- Department of Pharmacy, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung UniversityTainan 70101, Taiwan
| | - Pei-Ting Lee
- Department of Pharmacy, Kaohsiung Veterans General HospitalKaohsiung 813414, Taiwan
- Department of Public Health, College of Medicine, National Cheng Kung UniversityTainan 70101, Taiwan
| | - Yu-Hsun Chen
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Veterans General HospitalKaohsiung 81362, Taiwan
| | - Chao-Wen Hsu
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Veterans General HospitalKaohsiung 81362, Taiwan
- Department of Surgery, School of Medicine, National Yang Ming Chiao Tung UniversityTaipei 11221, Taiwan
| | - Yi-Chia Su
- Department of Pharmacy, Kaohsiung Veterans General HospitalKaohsiung 813414, Taiwan
- Department of Pharmacy, School of Pharmacy, Kaohsiung Medical UniversityKaohsiung 807378, Taiwan
- Department of Pharmacy, Chia-Nan University of Pharmacy and ScienceTainan 717301, Taiwan
- Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung UniversityTainan 70101, Taiwan
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13
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Ando M, Takemura N, Oikawa R, Yoshizaki Y, Inagaki F, Mihara F, Kiyomatsu T, Yamada K, Kokudo N. Secondary ileal lymph node metastases from rectal cancer: a case report. Surg Case Rep 2024; 10:117. [PMID: 38730129 PMCID: PMC11087430 DOI: 10.1186/s40792-024-01912-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/26/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Colorectal cancer can invade adjacent organs, but rarely metastasizes to the regional lymph nodes (LNs) of the invaded organ. Herein, we report a case of rectal cancer invading the ileum and metastasized to the regional ileal LNs. CASE PRESENTATION A 77-year-old male presented abdominal pain and anorexia, diagnosed with rectal cancer invading the small intestine and concurrently metastasized to the regional LN of the intestine and liver. High anterior resection and partial resection of the small intestine was performed, then, the patient was referred to our hospital for chemotherapy. We performed 17 cycles of systemic chemotherapy that achieved a partial reduction in size of the LN, followed by an ileocecal resection with ileal mesentery resection for regional LNs removal. Histopathological analysis of the resected ileal LNs and six liver lesions revealed a moderately differentiated tubular adenocarcinoma. The patient was discharged on postoperative day 18. Cancer recurrences developed in the lungs 5 months after the surgery, then to the liver and peritoneum, and further surgery and chemotherapy were performed. Despite the challenging presentation, the patient survived for 40 months after the first surgery. CONCLUSIONS We report a rare case of a surgical resection of a secondary ileal LN metastasis from rectal cancer. The patient survives for a relatively long time after surgical resection. When colorectal cancer invades the small intestine, clinicians should consider the possibility of secondary LN metastasis in the invaded site.
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Affiliation(s)
- Makoto Ando
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan
| | - Nobuyuki Takemura
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan.
| | - Ryo Oikawa
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan
| | - Yuhi Yoshizaki
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan
| | - Fuyuki Inagaki
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan
| | - Fuminori Mihara
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan
| | - Tomomichi Kiyomatsu
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan
| | - Kazuhiko Yamada
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan
| | - Norihiro Kokudo
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan
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14
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Rahbari NN, Biondo S, Frago R, Feißt M, Kreisler E, Rossion I, Serrano M, Jäger D, Lehmann M, Sommer F, Dignass A, Bolling C, Vogel I, Bork U, Büchler MW, Folprecht G, Kieser M, Lordick F, Weitz J. Primary Tumor Resection Before Systemic Therapy in Patients With Colon Cancer and Unresectable Metastases: Combined Results of the SYNCHRONOUS and CCRe-IV Trials. J Clin Oncol 2024; 42:1531-1541. [PMID: 38412408 DOI: 10.1200/jco.23.01540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/13/2023] [Accepted: 12/21/2023] [Indexed: 02/29/2024] Open
Abstract
PURPOSE Chemotherapy is established as primary treatment in patients with stage IV colorectal cancer and unresectable metastases. Data from nonrandomized clinical trials have fueled persistent uncertainty if primary tumor resection (PTR) before chemotherapy prolongs survival. We investigated the prognostic value of PTR in patients with newly diagnosed stage IV colon cancer who were not amenable to curative treatment. PATIENTS AND METHODS Patients enrolled in the multicenter, randomized SYNCHRONOUS and CCRe-IV trials were included in the analysis. Patients with colon cancer with synchronous unresectable metastases were randomly assigned at 100 sites in Austria, Germany, and Spain to undergo PTR or up-front chemotherapy (No PTR group). The chemotherapy regimen was left at discretion of the local team. Patients with tumor-related symptoms, inability to tolerate surgery and/or systemic chemotherapy, and history of another cancer were excluded. The primary end point was overall survival (OS), and the analyses were performed with intention-to-treat. RESULTS A total of 393 patients were randomly assigned to undergo PTR (n = 187) or no PTR (n = 206) between November 2011 and March 2017. Chemotherapy was not administered to 6.4% in the No PTR group and 24.1% in the PTR group. The median follow-up time was 36.7 months (95% CI, 36.6 to 37.3). The median OS was 16.7 months (95% CI, 13.2 to 19.2) in the PTR group and 18.6 months (95% CI, 16.2 to 22.3) in the No PTR group (P = .191). Comparable OS between the study groups was further confirmed on multivariate analysis (hazard ratio, 0.944 [95% CI, 0.738 to 1.209], P = .65) and across all subgroups. Patients with serious adverse events were more common in the No PTR group (10.2% v 18.0%; P = .027). CONCLUSION Among patients with colon cancer and synchronous unresectable metastases, PTR before systemic chemotherapy was not associated with prolonged OS.
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Affiliation(s)
- Nuh N Rahbari
- Department of Surgery, Ulm University hospital, Ulm, Germany
| | - Sebastiano Biondo
- Department of General and Digestive Surgery-Colorectal Unit, Bellvitge University Hospital, University of Barcelona and IDIBELL, Barcelona, Spain
| | - Ricardo Frago
- Department of General and Digestive Surgery-Colorectal Unit, Bellvitge University Hospital, University of Barcelona and IDIBELL, Barcelona, Spain
| | - Manuel Feißt
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Esther Kreisler
- Department of General and Digestive Surgery-Colorectal Unit, Bellvitge University Hospital, University of Barcelona and IDIBELL, Barcelona, Spain
| | - Inga Rossion
- The Study Center of the German Society of Surgery (SDGC), University of Heidelberg, Heidelberg, Germany
| | - Monica Serrano
- Department of General and Digestive Surgery-Colorectal Unit, Bellvitge University Hospital, University of Barcelona and IDIBELL, Barcelona, Spain
| | - Dirk Jäger
- Department of Medical Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Monika Lehmann
- Coordination Centre for Clinical Trials (KKS), University Hospital Heidelberg, Heidelberg, Germany
| | - Florian Sommer
- Department of General, Visceral and Transplantation Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Axel Dignass
- Department of Medicine I, Agaplesion Markus Hospital, Goethe-University, Frankfurt am Main, Germany
| | - Claus Bolling
- Department of Medicine I, Agaplesion Markus Hospital, Goethe-University, Frankfurt am Main, Germany
| | - Ilka Vogel
- Department of Surgery, Community Hospital Kiel, Kiel, Germany
| | - Ulrich Bork
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Markus W Büchler
- Department of General, Visceral and Transplantation Surgery, Medical Faculty Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
| | - Gunnar Folprecht
- Department of Medicine I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Meinhard Kieser
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Florian Lordick
- Department of Oncology, Gastroenterology, Hepatology, and Pulmonology, Comprehensive Cancer Center Central Germany (CCCG), University of Leipzig Medical Center, Leipzig, Germany
| | - Jürgen Weitz
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
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15
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Popescu I, Dudău AM, Dima S, Herlea V, Croitoru VM, Dinu IM, Miron M, Lupescu I, Croitoru-Cazacu IM, Dumitru R, Croitoru AE. Multimodal Treatment of Metastatic Rectal Cancer in a Young Patient: Case Report and Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:696. [PMID: 38792879 PMCID: PMC11123219 DOI: 10.3390/medicina60050696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/14/2024] [Accepted: 04/19/2024] [Indexed: 05/26/2024]
Abstract
Metastatic colorectal cancer requires a multidisciplinary and individualized approach. Herein, we reported the case of a young woman diagnosed with metastatic rectal cancer who received an individualized multimodal treatment strategy that resulted in a remarkable survival. There were several particular aspects of this case, such as the early onset of the disease, the successful use of conversion therapy, the application of liquid biopsy to guide treatment, and the specific nature of the bone metastasis. To offer more insights for navigating such challenges in patients with metastatic colorectal cancer, we have conducted a literature review to find more data related to the particularities of this case. The incidence of early onset colorectal cancer is on the rise. Data suggests that it differs from older-onset colorectal cancer in terms of its pathological, epidemiological, anatomical, metabolic, and biological characteristics. Conversion therapy and surgical intervention provide an opportunity for cure and improve outcomes in metastatic colorectal cancer. It is important to approach each case individually, as every patient with limited liver disease should be considered as a candidate for secondary resection. Moreover, liquid biopsy has an important role in the individualized management of metastatic colorectal cancer patients, as it offers additional information for treatment decisions.
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Affiliation(s)
- Ionuț Popescu
- Faculty of Medicine, Titu Maiorescu University, 040441 Bucharest, Romania; (I.P.); (V.M.C.)
| | - Ana-Maria Dudău
- Faculty of Medicine, Titu Maiorescu University, 040441 Bucharest, Romania; (I.P.); (V.M.C.)
- Medical Oncology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania; (I.M.D.); (M.M.); (I.M.C.-C.); (A.E.C.)
| | - Simona Dima
- Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, 020021 Bucharest, Romania; (S.D.); (V.H.); (I.L.); (R.D.)
- Center of Excellence in Translational Medicine, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Vlad Herlea
- Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, 020021 Bucharest, Romania; (S.D.); (V.H.); (I.L.); (R.D.)
- Pathology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Vlad M. Croitoru
- Faculty of Medicine, Titu Maiorescu University, 040441 Bucharest, Romania; (I.P.); (V.M.C.)
- Medical Oncology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania; (I.M.D.); (M.M.); (I.M.C.-C.); (A.E.C.)
| | - Ioana Mihaela Dinu
- Medical Oncology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania; (I.M.D.); (M.M.); (I.M.C.-C.); (A.E.C.)
| | - Monica Miron
- Medical Oncology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania; (I.M.D.); (M.M.); (I.M.C.-C.); (A.E.C.)
| | - Ioana Lupescu
- Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, 020021 Bucharest, Romania; (S.D.); (V.H.); (I.L.); (R.D.)
- Radiology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Irina M. Croitoru-Cazacu
- Medical Oncology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania; (I.M.D.); (M.M.); (I.M.C.-C.); (A.E.C.)
- Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, 020021 Bucharest, Romania; (S.D.); (V.H.); (I.L.); (R.D.)
| | - Radu Dumitru
- Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, 020021 Bucharest, Romania; (S.D.); (V.H.); (I.L.); (R.D.)
- Radiology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Adina Emilia Croitoru
- Medical Oncology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania; (I.M.D.); (M.M.); (I.M.C.-C.); (A.E.C.)
- Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, 020021 Bucharest, Romania; (S.D.); (V.H.); (I.L.); (R.D.)
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16
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Yang Y, Lam W, Lyu Z, Ouyang K, Chen R, Wang J, Wu D, Yang Z, Li Y. Predicting surgical benefit of primary tumor resection in patients with stage IV colorectal cancer. Asian J Surg 2024:S1015-9584(24)00606-7. [PMID: 38609833 DOI: 10.1016/j.asjsur.2024.03.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/12/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND There exists continuous controversy regarding the benefit of primary tumor resection (PTR) for stage IV colorectal cancer (CRC) patients. Little is known about how to predict the patients' benefit from PTR. This study aimed to develop a tool for surgical benefit prediction. METHODS Stage IV CRC patients diagnosed between 2010 and 2015 from the Surveillance, Epidemiology and End Results database were included. Patients receiving PTR who survived longer than the median cancer-specific survival (CSS) time of those who did not undergo PTR were considered to benefit from surgery. Logistic regression analysis identified prognostic factors influencing surgical benefit, based on which a nomogram was constructed. The data of patients who underwent PTR from our institution was used for external validation. A user-friendly webserver was then built for convenient clinical use. RESULTS The median CSS of the PTR group was 23 months, significantly longer than that of the non-PTR group (7 months, P < 0.001). In the PTR group, 23.3% of patients did not benefit from surgery. Logistic regression analysis identified age, marital status, tumor location, CEA level, chemotherapy, metastasectomy, tumor size, tumor deposits, number of examined lymph nodes, N stage, histological grade and number of distant metastases as independently associated with surgical benefit. The established prognostic nomogram demonstrated satisfactory performance in both the internal and external validation. CONCLUSION PTR was associated with prolonged CSS in stage IV CRC. The proposed nomogram could be used as an evidenced-based platform for risk-to-benefit assessment to select appropriate patients for undergoing PTR.
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Affiliation(s)
- Yuesheng Yang
- Shantou University Medical College, Shantou, 515041, Guangdong Province, PR China; Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong Province, PR China
| | - Waiting Lam
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong Province, PR China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangzhou, 510080, Guangdong Province, PR China
| | - Zejian Lyu
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong Province, PR China
| | - Kaibo Ouyang
- Shantou University Medical College, Shantou, 515041, Guangdong Province, PR China; Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong Province, PR China
| | - Ruijain Chen
- Shantou University Medical College, Shantou, 515041, Guangdong Province, PR China; Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong Province, PR China
| | - Junjiang Wang
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong Province, PR China
| | - Deqing Wu
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong Province, PR China
| | - Zifeng Yang
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong Province, PR China.
| | - Yong Li
- Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, Guangdong Province, PR China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong Province, PR China.
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17
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Nigam A, Li JWY, Fiasconaro M, Lin S, Capanu M, Kleiman DA, Memeh K, Raj N, Reidy-Lagunes DL, Untch BR. Morbidity and Outcomes of Primary Tumor Management in Patients with Widely Metastatic Well-Differentiated Small Bowel Neuroendocrine Tumors. Ann Surg Oncol 2024; 31:2337-2348. [PMID: 38036927 DOI: 10.1245/s10434-023-14637-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 11/06/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND The benefit of primary tumor resection in distant metastatic small bowel neuroendocrine tumors (SBNETs) is controversial, with treatment-based morbidity not well-defined. We aimed to determine the impact of primary tumor resection on development of disease-specific complications in patients with metastatic well-differentiated SBNETs. PATIENTS AND METHODS A retrospective analysis was performed of patients diagnosed with metastatic well-differentiated jejunal/ileal SBNETs at a single tertiary care cancer center from 1980 to 2016. Outcomes were compared on the basis of treatment selected at diagnosis between patients who underwent initial medical treatment or primary tumor resection. RESULTS Among 180 patients, 71 underwent medical management and 109 primary tumor resection. Median follow-up was 116 months. Median event-free survival did not differ between treatment approaches (log-rank p = 0.2). In patients medically managed first, 16/71 (23%) required surgery due to obstruction, perforation, or bleeding. These same complications led to resection at presentation in 31/109 (28%) surgically treated patients. Development of an obstruction from the primary tumor was not associated with disease progression/recurrence (HR 1.14, 95% CI 0.75-1.75) with all patients recovering postoperatively. Ongoing tumor progression requiring secondary laparotomy was associated with worse mortality (HR 7.51, 95% CI 3.3-16.9; p < 0.001) and occurred in 20/109 (18%) primary tumor resection and 7/16 (44%) initially medically treated patients. CONCLUSIONS Rates of event-free survival among patients with metastatic SBNETs do not differ on the basis of primary tumor management. The development of an obstruction from the primary tumor was not associated with worse outcomes with all patients salvaged. Regardless of initial treatment selected, patients with metastatic SBNET should be closely followed for early signs of primary tumor complications.
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Affiliation(s)
- Aradhya Nigam
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Janet W Y Li
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Megan Fiasconaro
- Department of Epidemiology and Statistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sabrina Lin
- Department of Epidemiology and Statistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marinela Capanu
- Department of Epidemiology and Statistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David A Kleiman
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Kelvin Memeh
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nitya Raj
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Brian R Untch
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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18
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van Nassau SCMW, Bol GM, van der Baan FH, Roodhart JML, Vink GR, Punt CJA, May AM, Koopman M, Derksen JWG. Harnessing the Potential of Real-World Evidence in the Treatment of Colorectal Cancer: Where Do We Stand? Curr Treat Options Oncol 2024; 25:405-426. [PMID: 38367182 PMCID: PMC10997699 DOI: 10.1007/s11864-024-01186-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 02/19/2024]
Abstract
OPINION STATEMENT Treatment guidelines for colorectal cancer (CRC) are primarily based on the results of randomized clinical trials (RCTs), the gold standard methodology to evaluate safety and efficacy of oncological treatments. However, generalizability of trial results is often limited due to stringent eligibility criteria, underrepresentation of specific populations, and more heterogeneity in clinical practice. This may result in an efficacy-effectiveness gap and uncertainty regarding meaningful benefit versus treatment harm. Meanwhile, conduct of traditional RCTs has become increasingly challenging due to identification of a growing number of (small) molecular subtypes. These challenges-combined with the digitalization of health records-have led to growing interest in use of real-world data (RWD) to complement evidence from RCTs. RWD is used to evaluate epidemiological trends, quality of care, treatment effectiveness, long-term (rare) safety, and quality of life (QoL) measures. In addition, RWD is increasingly considered in decision-making by clinicians, regulators, and payers. In this narrative review, we elaborate on these applications in CRC, and provide illustrative examples. As long as the quality of RWD is safeguarded, ongoing developments, such as common data models, federated learning, and predictive modelling, will further unfold its potential. First, whenever possible, we recommend conducting pragmatic trials, such as registry-based RCTs, to optimize generalizability and answer clinical questions that are not addressed in registrational trials. Second, we argue that marketing approval should be conditional for patients who would have been ineligible for the registrational trial, awaiting planned (non) randomized evaluation of outcomes in the real world. Third, high-quality effectiveness results should be incorporated in treatment guidelines to aid in patient counseling. We believe that a coordinated effort from all stakeholders is essential to improve the quality of RWD, create a learning healthcare system with optimal use of trials and real-world evidence (RWE), and ultimately ensure personalized care for every CRC patient.
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Affiliation(s)
- Sietske C M W van Nassau
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, PO Box 85500, Utrecht, 3584 CX, The Netherlands.
| | - Guus M Bol
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, PO Box 85500, Utrecht, 3584 CX, The Netherlands
| | - Frederieke H van der Baan
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, PO Box 85500, Utrecht, 3584 CX, The Netherlands
- Department of Epidemiology & Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jeanine M L Roodhart
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, PO Box 85500, Utrecht, 3584 CX, The Netherlands
| | - Geraldine R Vink
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, PO Box 85500, Utrecht, 3584 CX, The Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Cornelis J A Punt
- Department of Epidemiology & Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anne M May
- Department of Epidemiology & Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, PO Box 85500, Utrecht, 3584 CX, The Netherlands
| | - Jeroen W G Derksen
- Department of Epidemiology & Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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19
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Beppu T, Yamamura K, Imai K, Hayashi H, Miyamoto Y. Recurrence-risk stratification using the Beppu score and selection of perioperative chemotherapy for colorectal liver metastases. J Surg Oncol 2024; 129:893-900. [PMID: 38239092 DOI: 10.1002/jso.27590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/06/2024] [Indexed: 04/02/2024]
Abstract
The annual postoperative disease-free survival for colorectal liver metastases can be easily estimated by weighting six preoperative clinical parameters (Beppu score). We identified three recurrence-risk stratification groups: the low (≤6 points), moderate (7-10 points), and high-risk (≥11 points). For low-, moderate-, and high-risk patients, hepatectomy alone, hepatectomy with adjuvant chemotherapy, and hepatectomy with preoperative chemotherapy are recommended, respectively. The Beppu score enables the decision on the necessity and timing of perioperative chemotherapy.
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Affiliation(s)
- Toru Beppu
- Department of Surgery, Yamaga City Medical Center, Yamaga, Japan
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Kensuke Yamamura
- Department of Surgery, Yamaga City Medical Center, Yamaga, Japan
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Katsunori Imai
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiromitsu Hayashi
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yuji Miyamoto
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
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20
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Palko-Łabuz A, Wesołowska O, Błaszczyk M, Uryga A, Sobieszczańska B, Skonieczna M, Kostrzewa-Susłow E, Janeczko T, Środa-Pomianek K. Methoxychalcones as potential anticancer agents for colon cancer: Is membrane perturbing potency relevant? Biochim Biophys Acta Gen Subj 2024; 1868:130581. [PMID: 38336309 DOI: 10.1016/j.bbagen.2024.130581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/18/2023] [Accepted: 02/04/2024] [Indexed: 02/12/2024]
Abstract
Chalcones are naturally produced by many plants, and constitute precursors for the synthesis of flavons and flavanons. They were shown to possess antibacterial, antifungal, anti-cancer, and anti- inflammatory properties. The goal of the study was to assess the suitability of three synthetic methoxychalcones as potential anticancer agents. In a panel of colon cancer cell lines they were demonstrated to be cytotoxic, proapoptotic, causing cell cycle arrest, and increasing intracellular level of reactive oxygen species. Anticancer activity of the compounds was not diminished in the presence of stool extract containing microbial enzymes that could change the structure of chalcones. Moreover, methoxychalcones interacted strongly with model phosphatidylcholine membranes as detected by differential scanning calorimetry. Metohoxychalcones particularly affected the properties of lipid domains in giant unilamellar liposomes formed from raft-mimicking lipid composition. This may be of importance since many molecular targets for therapy of metastatic colon cancer are raft-associated receptors (e.g., receptor tyrosine kinases). The importance of membrane perturbing potency of methoxychalcones for their biological activity was additionally corroborated by the results obtained by molecular modelling.
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Affiliation(s)
- Anna Palko-Łabuz
- Department of Biophysics and Neuroscience, Wroclaw Medical University, Wroclaw, Poland.
| | - Olga Wesołowska
- Department of Biophysics and Neuroscience, Wroclaw Medical University, Wroclaw, Poland
| | - Maria Błaszczyk
- Department of Biophysics and Neuroscience, Wroclaw Medical University, Wroclaw, Poland
| | - Anna Uryga
- Department of Biophysics and Neuroscience, Wroclaw Medical University, Wroclaw, Poland
| | | | - Magdalena Skonieczna
- Department of Systems Biology and Engineering, The Silesian University of Technology, Gliwice, Poland; Biotechnology Centre, Silesian University of Technology, Gliwice, Poland
| | - Edyta Kostrzewa-Susłow
- Department of Food Chemistry and Biocatalysis, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
| | - Tomasz Janeczko
- Department of Food Chemistry and Biocatalysis, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
| | - Kamila Środa-Pomianek
- Department of Biophysics and Neuroscience, Wroclaw Medical University, Wroclaw, Poland
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21
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Yu G, Liu S, Wang Z, Liu Q, Ren H, Hu W. Palliative primary tumor resection may not offer survival benefits for patients with unresectable metastatic colorectal neuroendocrine neoplasms, one multicenter retrospective cohort study. BMC Surg 2024; 24:85. [PMID: 38475759 DOI: 10.1186/s12893-024-02380-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 03/04/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND The efficacy of palliative primary tumor resection (PTR) in improving prognosis for patients with unresectable metastatic colorectal neuroendocrine neoplasms (NENs) has not been fully explored. METHODS We performed one retrospective cohort study and recruited 68 patients with unresectable metastatic colorectal NENs from two Chinese medical centers between 2000 and 2022. All patients were assigned to PTR group and no PTR group. The clinicopathological manifestation data were carefully collected, and the survival outcomes were compared between the two groups using Kaplan-Meier methods. Propensity score matching (PSM) was conducted to minimize confounding bias. Univariate and multivariate Cox proportional hazards regression analyses were performed to identify prognostic factors. RESULTS A total of 32 patients received PTR, and the other 36 patients did not. The median progression-free survival (PFS) and overall survival (OS) times were 4 and 22 months in the whole cohort, respectively. For patients who received no PTR, the median OS was 16 months, and the 1-year OS rate and 3-year OS rate were 56.4% and 39.6%, respectively. For patients who received PTR, the median OS was 24 months, and the 1-year OS rate and 3-year OS rate were 67.9% and 34.1%, respectively. However, the Kaplan-Meier survival curves and log-rank test demonstrated no significant survival difference between the two groups (P = 0.963). Moreover, palliative PTR was also not confirmed as a prognostic factor in subsequent univariable and multivariable Cox proportional hazards regression analyses in both the original and matched cohorts. Only histological differentiation was identified as an independent prognostic factor affecting PFS [hazard ratio (HR) = 1.86, 95% confidence interval (CI): 1.02-3.41, P = 0.043] and OS [HR = 3.70, 95% CI: 1.09-12.48, P = 0.035] in the original cohort. CONCLUSIONS Palliative PTR may not offer survival benefits for patients with unresectable metastatic colorectal NENs.
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Affiliation(s)
- Guozhi Yu
- Department of Colorectal and Anal Surgery, Beijing Erlonglu Hospital, Beijing, 100016, China
| | - Shen Liu
- Department of Colorectal Surgery, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Zhijie Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Qian Liu
- Department of Colorectal Surgery, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Hongchang Ren
- Department of General Surgery, Strategic Support Force Medical Center, No.9, Anxiang North, Desheng Gate, Chaoyang District, Beijing, 100101, China.
| | - Wenhui Hu
- Department of Colorectal Surgery, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
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22
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Aho S, Osterlund E, Ristimäki A, Nieminen L, Sundström J, Mäkinen MJ, Kuopio T, Kytölä S, Ålgars A, Ristamäki R, Heervä E, Kallio R, Halonen P, Soveri LM, Nordin A, Uutela A, Salminen T, Stedt H, Lamminmäki A, Muhonen T, Kononen J, Glimelius B, Isoniemi H, Lehto JT, Lehtomäki K, Osterlund P. Impact of Primary Tumor Location on Demographics, Resectability, Outcomes, and Quality of Life in Finnish Metastatic Colorectal Cancer Patients (Subgroup Analysis of the RAXO Study). Cancers (Basel) 2024; 16:1052. [PMID: 38473410 DOI: 10.3390/cancers16051052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
The primary tumor location (PTL) is associated with the phenotype, metastatic sites, mutations, and outcomes of metastatic colorectal cancer (mCRC) patients, but this has mostly been studied according to sidedness (right vs. left sided). We studied right colon vs. left colon vs. rectal PTL in a real-life study population (n = 1080). Health-related quality of life (HRQoL) was assessed multi-cross-sectionally with QLQ-C30, QLQ-CR29, EQ-5D, and 15D. A chi-square, Kaplan-Meier, and Cox regression were used to compare the groups. The PTL was in the right colon in 310 patients (29%), the left colon in 396 patients (37%), and the rectum in 375 patients (35%). The PTL was associated with distinct differences in metastatic sites during the disease trajectory. The resectability, conversion, and resection rates were lowest in the right colon, followed by the rectum, and were highest in the left colon. Overall survival was shortest for right colon compared with left colon or rectal PTL (median 21 vs. 35 vs. 36 months), with the same trends after metastasectomy or systemic therapy only. PTL also remained statistically significant in a multivariable model. The distribution of symptoms varied according to PTL, especially between the right colon (with general symptoms of metastases) and rectal PTL (with sexual- and bowel-related symptoms). mCRC, according to PTL, behaves differently regarding metastatic sites, resectability of the metastases, outcomes of treatment, and HRQoL.
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Grants
- 2016, 2018, 2019, 2020, 2021, 2022, 2023 Finska Läkaresällskapet
- 2019-2020, 2021, 2022-2023 Finnish Cancer Registry
- 2020-2022 Relanderin säätiö
- 2012, 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023 Competitive State Research Financing of the Expert Responsibility Area of Tampere, Helsinki, Turku, Kuopio, Oulu, and Satakunta Hospitals
- Tukisäätiö 2019, 2020, 2023 and OOO-project 2020 Tampere University Hospital
- 2019, 2020, 2021, 2022, 2023 Helsinki University Hospital
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Affiliation(s)
- Sonja Aho
- Department of Oncology, Tays Cancer Centre, Tampere University Hospital, Elämänaukio 2, 33520 Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 23, 33520 Tampere, Finland
- TUNI Palliative Care Research Group, Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 23, 33520 Tampere, Finland
- Palliative Care Centre, Tampere University Hospital, Elämänaukio 2, 33520 Tampere, Finland
| | - Emerik Osterlund
- Department of Immunology, Genetics and Pathology, Uppsala University, 75185 Uppsala, Sweden
- Department of Transplantation and Liver Surgery, Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
| | - Ari Ristimäki
- Department of Pathology, HUSLAB, HUS Diagnostic Center, Helsinki University Hospital, Haartmaninkatu 3, 00290 Helsinki, Finland
- Applied Tumor Genomics Research Program, Research Programs Unit, Faculty of Medicine, University of Helsinki, Haartmaninkatu 8, 00290 Helsinki, Finland
| | - Lasse Nieminen
- Department of Pathology, FIMLAB, Tampere University Hospital, Elämänaukio 2, 33520 Tampere, Finland
- Department of Pathology, University of Tampere, Arvo Ylpön katu 23, 33520 Tampere, Finland
| | - Jari Sundström
- Department of Pathology, Turku University Hospital, Kiinanmyllynkatu 4-8, 20520 Turku, Finland
- Institute of Biomedicine, University of Turku, Kiinanmyllynkatu 10, 20520 Turku, Finland
| | - Markus J Mäkinen
- Department of Pathology, Oulu University Hospital, Kajaanintie 50, 90220 Oulu, Finland
- Translational Medicine Research Unit, Department of Pathology, University of Oulu, Pentti Kaiteran katu 1, 90570 Oulu, Finland
- Medical Research Center Oulu, Pentti Kaiteran katu 1, 90570 Oulu, Finland
| | - Teijo Kuopio
- Department of Pathology, Hospital Nova, Hoitajantie 3, 40620 Jyväskylä, Finland
- Department of Biological and Environmental Science, University of Jyväskylä, Seminaarinkatu 15, 40014 Jyväskylän yliopisto, Finland
| | - Soili Kytölä
- Department of Genetics, HUSLAB, HUS Diagnostic Center, Helsinki University Hospital, Haartmaninkatu 3, 00290 Helsinki, Finland
- Department of Genetics, University of Helsinki, Haartmaninkatu 8, 00290 Helsinki, Finland
| | - Annika Ålgars
- Department of Oncology, Turku University Hospital and University of Turku, Hämeentie 11, 20520 Turku, Finland
| | - Raija Ristamäki
- Department of Oncology, Turku University Hospital and University of Turku, Hämeentie 11, 20520 Turku, Finland
| | - Eetu Heervä
- Department of Oncology, Turku University Hospital and University of Turku, Hämeentie 11, 20520 Turku, Finland
| | - Raija Kallio
- Department of Oncology, Oulu University Hospital, Kajaanintie 50, 90220 Oulu, Finland
- Department of Oncology, University of Oulu, Pentti Kaiteran katu 1, 90570 Oulu, Finland
| | - Päivi Halonen
- Department of Oncology, Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
- Department of Oncology, University of Helsinki, Haartmaninkatu 8, 00290 Helsinki, Finland
| | - Leena-Maija Soveri
- Department of Oncology, University of Helsinki, Haartmaninkatu 8, 00290 Helsinki, Finland
- Home Care, Joint Municipal Authority for Health Care and Social Services in Keski-Uusimaa, Sairaalakatu 1, 05850 Hyvinkää, Finland
| | - Arno Nordin
- Department of Transplantation and Liver Surgery, Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
- Department of Surgery, University of Helsinki, Haartmaninkatu 8, 00290 Helsinki, Finland
| | - Aki Uutela
- Department of Transplantation and Liver Surgery, Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
- Department of Surgery, University of Helsinki, Haartmaninkatu 8, 00290 Helsinki, Finland
| | - Tapio Salminen
- Department of Oncology, Tays Cancer Centre, Tampere University Hospital, Elämänaukio 2, 33520 Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 23, 33520 Tampere, Finland
| | - Hanna Stedt
- Department of Oncology, Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland
- Faculty of Health Sciences, University of Eastern Finland, Yliopistonranta 1A, 70210 Kuopio, Finland
| | - Annamarja Lamminmäki
- Department of Oncology, Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland
- Faculty of Health Sciences, University of Eastern Finland, Yliopistonranta 1A, 70210 Kuopio, Finland
| | - Timo Muhonen
- Department of Oncology, University of Helsinki, Haartmaninkatu 8, 00290 Helsinki, Finland
- Department of Oncology, South Carelia Central Hospital, Valto Käkelän Katu 1, 53130 Lappeenranta, Finland
| | - Juha Kononen
- Docrates Cancer Centre, Docrates Hospital, Saukonpaadenranta 2, 00180 Helsinki, Finland
- Department of Oncology, Hospital Nova, Hoitajankatu 3, 40620 Jyväskylä, Finland
| | - Bengt Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, 75185 Uppsala, Sweden
| | - Helena Isoniemi
- Department of Transplantation and Liver Surgery, Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
- Department of Surgery, University of Helsinki, Haartmaninkatu 8, 00290 Helsinki, Finland
| | - Juho T Lehto
- TUNI Palliative Care Research Group, Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 23, 33520 Tampere, Finland
- Palliative Care Centre, Tampere University Hospital, Elämänaukio 2, 33520 Tampere, Finland
| | - Kaisa Lehtomäki
- Department of Oncology, Tays Cancer Centre, Tampere University Hospital, Elämänaukio 2, 33520 Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 23, 33520 Tampere, Finland
| | - Pia Osterlund
- Department of Oncology, Tays Cancer Centre, Tampere University Hospital, Elämänaukio 2, 33520 Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 23, 33520 Tampere, Finland
- Department of Oncology, Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
- Department of Oncology, University of Helsinki, Haartmaninkatu 8, 00290 Helsinki, Finland
- Department of Gastrointestinal Oncology, Karolinska Universitetssjukhuset, Eugeniavägen 3, 17176 Solna, Sweden
- Department of Oncology/Pathology, Karolinska Institutet, Solnavägen 1, 17177 Solna, Sweden
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23
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Choo JM, Ryu HS, Kim JS, Cheong JY, Baek SJ, Kwak JM, Kim J. Conversational artificial intelligence (chatGPT™) in the management of complex colorectal cancer patients: early experience. ANZ J Surg 2024; 94:356-361. [PMID: 37905713 DOI: 10.1111/ans.18749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 10/05/2023] [Accepted: 10/13/2023] [Indexed: 11/02/2023]
Abstract
INTRODUCTION In 2022 chatGPT™ (OpenAI, San Francisco) was introduced to the public. The complex reasoning and the natural language processing (NLP) ability of the AI platform has generated much excitement about the potential applications. This study conducted a preliminary analysis of the chatGPT™'s ability to formulate a management plan in accordance with oncological principles for patients with colorectal cancer. METHODOLOGY Colorectal cancer cases discussed in the multidisciplinary tumor (MDT) board at a single tertiary institution between September 2022 and January 2023 were prospectively collected. The treatment recommendations made by the chatGPT™ for Stage IV, recurrent, synchronous colorectal cancer were analysed for adherence to oncological principles. The recommendations by chatGPT™ were compared with the decision plans made by the MDT. RESULTS In all cases, the chatGPT™ was able to adhere to oncological principles. The recommendations in all 30 cases factored in the patient's overall health and functional status. The oncological management recommendation concordance rate between chatGPT™ and the MDT was 86.7%. CONCLUSIONS This study shows a high concordance rate of the chatGPT™'s recommendations with that given by the MDT in the management of complex colorectal patients. This will need to be verified in a larger prospective study.
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Affiliation(s)
- Jeong Min Choo
- Korea University Anam Hospital, Division of Colon and Rectal Surgery, Department of Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Hyo Seon Ryu
- Korea University Anam Hospital, Division of Colon and Rectal Surgery, Department of Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Ji Seon Kim
- Korea University Anam Hospital, Division of Colon and Rectal Surgery, Department of Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Ju Yong Cheong
- Korea University Anam Hospital, Division of Colon and Rectal Surgery, Department of Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Se-Jin Baek
- Korea University Anam Hospital, Division of Colon and Rectal Surgery, Department of Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Jung Myun Kwak
- Korea University Anam Hospital, Division of Colon and Rectal Surgery, Department of Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Jin Kim
- Korea University Anam Hospital, Division of Colon and Rectal Surgery, Department of Surgery, Korea University College of Medicine, Seoul, South Korea
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24
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Nakao E, Kawamura H, Honda M, Takano Y, Kinuta S, Kamiga T, Yamazaki S, Muto A, Shiraso S, Yamashita N, Iwao T, Kono K, Konno S. Prognostic impact and survival outcomes of colon perforation in patients with metastatic colorectal cancer: a multicenter retrospective cohort study. Int J Clin Oncol 2024; 29:179-187. [PMID: 38078975 DOI: 10.1007/s10147-023-02444-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/18/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Colon perforation caused by colorectal cancer (CRC) is a fatal condition requiring emergency intervention. For patients with metastatic lesions, surgeons face difficult decisions regarding whether to resect the primary and metastatic lesions. Moreover, there is currently no established treatment strategy for these patients. This study aimed to investigate the clinical practice and long-term outcomes of patients with metastatic CRC diagnosed with the onset of colon perforation. METHODS We performed a population-based multicenter cohort study. Consecutive patients diagnosed with stage IV CRC between 2008 and 2015 at all designated cancer hospitals in Fukushima Prefecture, Japan, were enrolled in this study. We evaluated the impact of colon perforation on the survival outcomes of patients with metastatic CRC. The main outcome was the adjusted hazard ratio (aHR) of perforation for overall survival (OS). Survival time and HRs were estimated using Kaplan‒Meier and Cox proportional regression analyses. RESULTS A total of 1258 patients were enrolled (perforation: n = 46; non-perforation: n = 1212). All but one of the patients with perforation underwent primary resection or colostomy and 25 cases were able to receive chemotherapy. The median OS for the perforation and non-perforation groups was 19.0 and 20.0 months, respectively (p = 0.96). Moreover, perforation was not an independent prognostic factor (aHR: 0.99; 95% confidence interval: 0.61-1.28). CONCLUSIONS In metastatic CRC, perforation is not necessarily a poor prognostic factor. Patients with perforation who undergo primary tumor resection or colostomy and prompt initiation of systemic chemotherapy might be expected to have a survival time similar to that of patients with non-perforated colon.
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Affiliation(s)
- Eiichi Nakao
- Department of Minimally Invasive Surgical and Medical Oncology, FUKUSHIMA Medical University, 1 Hikarigaoka Fukushima-shi, Fukushima, Fukushima, 960-1295, Japan.
- Department of Surgery, Southern TOHOKU General Hospital, 7-115 Yatsuyamada Koriyama-shi, Koriyama, Fukushima, 963-8563, Japan.
| | - Hidetaka Kawamura
- Department of Minimally Invasive Surgical and Medical Oncology, FUKUSHIMA Medical University, 1 Hikarigaoka Fukushima-shi, Fukushima, Fukushima, 960-1295, Japan
| | - Michitaka Honda
- Department of Minimally Invasive Surgical and Medical Oncology, FUKUSHIMA Medical University, 1 Hikarigaoka Fukushima-shi, Fukushima, Fukushima, 960-1295, Japan
| | - Yoshinao Takano
- Department of Surgery, Southern TOHOKU General Hospital, 7-115 Yatsuyamada Koriyama-shi, Koriyama, Fukushima, 963-8563, Japan
| | - Shunji Kinuta
- Department of Surgery, The Takeda Healthcare Foundation Takeda General Hospital, Aizu Wakamatsu, -27 Yamagamachi Aizuwakamatsu-shi, Fukushima, Fukushima, 965-8585, Japan
| | - Takahiro Kamiga
- Department of Surgery, Shirakawa Kosei General Hospital, 2-1 Toyochi Kamiyajiro Shirakawa-shi, Shirakawa, Fukushima, 961-0005, Japan
| | - Shigeru Yamazaki
- Department of Surgery, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi Koriyama-shi, Koriyama, Fukushima, 963-8558, Japan
| | - Atsushi Muto
- Department of Surgery, Fukushima Rosai Hospital, 3 Uchigotsuzuramachi Numajiri Iwaki-shi, Iwaki, Fukushima, 973-8403, Japan
| | - Satoru Shiraso
- Department of Surgery, Iwaki Kyoritsu General Hospital, 16 Uchigomimayamachi Kuzehara Iwaki-shi, Iwaki, Fukushima, 973-8555, Japan
| | - Naoyuki Yamashita
- Department of Surgery, Tsuboi Hospital, 1-10-13 Asakamachi Nagakubo Koriyama-shi, Koriyama, Fukushima, 963-0105, Japan
| | - Toshiyasu Iwao
- Department of Gastroenterology, Aizu Chuo Hospital, 1-1 Tsurugacho Aizuwakamatsu-shi, Aizu Wakamatsu, Fukushima, 965-8611, Japan
| | - Koji Kono
- Department of Minimally Invasive Surgical and Medical Oncology, FUKUSHIMA Medical University, 1 Hikarigaoka Fukushima-shi, Fukushima, Fukushima, 960-1295, Japan
- Department of Gastrointestinal Tract Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima-shi, Fukushima, Fukushima, 960-1295, Japan
| | - Shinichi Konno
- Department of Minimally Invasive Surgical and Medical Oncology, FUKUSHIMA Medical University, 1 Hikarigaoka Fukushima-shi, Fukushima, Fukushima, 960-1295, Japan
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Verheij FS, Yuval JB, Kok NFM, Lin ST, Qin LX, Omer DM, Thompson HM, Wei IH, Widmar M, Pappou EP, Weiser MR, Nash GM, Smith JJ, Paty PB, Beets GL, Garcia-Aguilar J. Nonoperative management of the primary tumor in patients with unresectable stage IV colon cancer treated with systemic chemotherapy: Higher complication rates for left-sided colon tumors. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107294. [PMID: 38039906 PMCID: PMC10841609 DOI: 10.1016/j.ejso.2023.107294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 11/02/2023] [Accepted: 11/17/2023] [Indexed: 12/03/2023]
Abstract
INTRODUCTION Treatment of the primary tumor in asymptomatic patients with unresectable colorectal metastases remains controversial. METHODS Data from patients with synchronous stage IV colon cancer and an untreated primary tumor who started treatment aimed at metastatic disease at a specialized cancer center between 2014 and 2018 were analyzed retrospectively. Main outcome was primary tumor-related complications comparing left-sided and right-sided colon cancer. A competing-risk regression model was used to identify predictors of complications. RESULTS Of 523 patients with metastatic colon cancer at presentation, 221 started treatment aimed at metastatic disease; these patients constituted the study cohort. The primary tumor was left-sided in 109 patients (49%) and right-sided in 112 patients (51%). In total, 46 patients (21%) developed a complication that required invasive intervention. Complications occurred more frequently in patients with left-sided tumors than in patients with right-sided tumors (29% vs 13%, P = 0.003). Eighteen patients (8%) underwent non-surgical intervention. Six patients (33%) failed non-surgical management and underwent surgery. Of 34 patients (15%) who underwent surgical intervention, 20 underwent an emergency colectomy and 14 underwent diversion with a permanent stoma. Overall, 10% of patients ended up with a permanent stoma. In competing-risk analysis, only left-sided primary tumor (hazard ratio 2.62; 95% CI 1.40-4.89; P = 0.003) was significantly associated with primary tumor-related complications requiring invasive intervention. CONCLUSIONS Patients with asymptomatic metastatic left-sided tumors have a higher risk for primary tumor-related complications than patients with right-sided tumors. Close monitoring and early surgical rescue should be considered for patients with left-sided colon cancer who are managed nonoperatively.
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Affiliation(s)
- Floris S Verheij
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands; GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
| | - Jonathan B Yuval
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Niels F M Kok
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Sabrina T Lin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Li-Xuan Qin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Dana M Omer
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hannah M Thompson
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Iris H Wei
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maria Widmar
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emmanouil P Pappou
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Martin R Weiser
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Garrett M Nash
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - J Joshua Smith
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Philip B Paty
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Geerard L Beets
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands; GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
| | - Julio Garcia-Aguilar
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Miura T, Morohashi H, Sakamoto Y, Kagiya T, Hasebe T, Nakayama Y, Fujita H, Hakamada K. Neoadjuvant S-1 and oxaliplatin plus bevacizumab therapy for high-risk locally advanced rectal cancer: A prospective multicenter phase II study. Ann Gastroenterol Surg 2024; 8:71-79. [PMID: 38250676 PMCID: PMC10797815 DOI: 10.1002/ags3.12720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/05/2023] [Accepted: 07/06/2023] [Indexed: 01/23/2024] Open
Abstract
Aim We report the short/mid-term results of surgery for high-risk locally advanced rectal cancer (LARC) after neoadjuvant chemotherapy (NAC, four courses of S-1 + oxaliplatin+ bevacizumab) without radiotherapy with the primary aim of ypT0-2. Methods High-risk LARC was defined as cT4b, mesorectal fascia (MRF) ≤1 mm (MRF+), or lateral lymph node metastasis (cLLN+) on high-resolution MRI. The planned 32 cases from April 2018 to December 2021 were all included. Results There were 10 patients at cT4b (31.2%), 26 MRF+ (81.3%), and 22 cLLN+ (68.8%). Thirteen (40.6%) underwent NAC after a colostomy for stenosis. NAC was completed in 26 (81.2%) cases. Grade 3 or higher adverse events occurred in six (18.7%). One patient developed progressive disease (3.2%). Eleven were ycT0-3MRF-LLN- (34.3%). Curative-intent surgery was performed on 31, with sphincter-preserving surgery in 20, abdominoperineal resection in nine, total pelvic exenteration in two, and lateral lymph node dissection in 24. Two had R1/2 resection (6.4%). A Grade 3 or higher postoperative complication rate occurred in 3.2%. Pathological complete response and ypT0-2 rates were 12.9% and 45.1%. Three-year disease-free survival rates (3yDFS) for ypT0-2 and ypT ≥3 were 81.2%, 46.6% (p = 0.061), and 3-year local recurrence rates (3yLR) were 0%, 48.8% (p = 0.015). 3yDFS for ycT0-3MRF-LLN- and ycT4/MRF+/LLN+ were 87.5%, 48.0% (p = 0.031) and 3yLR were 0%, 42.8% (p = 0.045). Conclusion NAC yielded a clinically significant effect in about half of high-risk LARC patients. If NAC alone is ineffective, radiotherapy should be added, even if extended surgery is intended.
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Affiliation(s)
- Takuya Miura
- Department of Gastroenterological SurgeryHirosaki University Graduate School of MedicineHirosakiJapan
| | - Hajime Morohashi
- Department of Gastroenterological SurgeryHirosaki University Graduate School of MedicineHirosakiJapan
| | - Yoshiyuki Sakamoto
- Department of Gastroenterological SurgeryHirosaki University Graduate School of MedicineHirosakiJapan
| | - Takuji Kagiya
- Department of Gastroenterological SurgeryHirosaki University Graduate School of MedicineHirosakiJapan
| | - Tatsuya Hasebe
- Department of SurgeryOdate Municipal General HospitalOdateJapan
| | | | - Hiromasa Fujita
- Department of RadiologyHirosaki University Graduate School of MedicineHirosakiJapan
| | - Kenichi Hakamada
- Department of Gastroenterological SurgeryHirosaki University Graduate School of MedicineHirosakiJapan
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Sun X, Yang Y, Meng X, Li J, Liu X, Liu H. PANoptosis: Mechanisms, biology, and role in disease. Immunol Rev 2024; 321:246-262. [PMID: 37823450 DOI: 10.1111/imr.13279] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/16/2023] [Accepted: 09/19/2023] [Indexed: 10/13/2023]
Abstract
Cell death can be executed through distinct subroutines. PANoptosis is a unique inflammatory cell death modality involving the interactions between pyroptosis, apoptosis, and necroptosis, which can be mediated by multifaceted PANoptosome complexes assembled via integrating components from other cell death modalities. There is growing interest in the process and function of PANoptosis. Accumulating evidence suggests that PANoptosis occurs under diverse stimuli, for example, viral or bacterial infection, cytokine storm, and cancer. Given the impact of PANoptosis across the disease spectrum, this review briefly describes the relationships between pyroptosis, apoptosis, and necroptosis, highlights the key molecules in PANoptosome formation and PANoptosis activation, and outlines the multifaceted roles of PANoptosis in diseases together with a potential for therapeutic targeting. We also discuss important concepts and pressing issues for future PANoptosis research. Improved understanding of PANoptosis and its mechanisms is crucial for identifying novel therapeutic targets and strategies.
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Affiliation(s)
- Xu Sun
- Department of Integrated Chinese and Western Medicine, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, China
| | - Yanpeng Yang
- Cardiac Care Unit, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Xiaona Meng
- Department of Integrated Chinese and Western Medicine, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, China
| | - Jia Li
- Department of Integrated Chinese and Western Medicine, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, China
| | - Xiaoli Liu
- Department of Integrated Chinese and Western Medicine, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, China
| | - Huaimin Liu
- Department of Integrated Chinese and Western Medicine, Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, China
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White MJ, Jensen EH, Brauer DG. A Review of Resection and Surgical Ablation for Primary and Secondary Liver Cancers. Semin Intervent Radiol 2023; 40:536-543. [PMID: 38274223 PMCID: PMC10807965 DOI: 10.1055/s-0043-1777747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
The surgical management of primary and secondary liver tumors is constantly evolving. Patient selection, particularly with regard to determining resectability, is vital to the success of programs directed toward invasive treatments of liver tumors. Particular attention should be paid toward determining whether patients are best served with surgical resection or ablative therapies. A multidisciplinary approach is necessary to provide optimal care to patients with liver malignancy.
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Affiliation(s)
- McKenzie J. White
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Eric H. Jensen
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - David G. Brauer
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
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29
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Fanotto V, Rossini D, Casagrande M, Bergamo F, Spagnoletti A, Santini D, Antoniotti C, Cupini S, Daniel F, Nasca V, Vetere G, Zaniboni A, Borelli B, Carullo M, Conca V, Passardi A, Tamburini E, Masi G, Pella N, Cremolini C. Primary Tumor Resection in Synchronous Metastatic Colorectal Cancer Patients Treated with Upfront Chemotherapy plus Bevacizumab: A Pooled Analysis of TRIBE and TRIBE2 Studies. Cancers (Basel) 2023; 15:5451. [PMID: 38001711 PMCID: PMC10670103 DOI: 10.3390/cancers15225451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/08/2023] [Accepted: 11/11/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND The decision to resect or not the primary tumor in asymptomatic patients with synchronous metastatic colorectal cancer (mCRC) is a complex and challenging issue for oncologists, especially when an antiangiogenic-based therapy is planned. METHODS Patients enrolled in the phase III TRIBE and TRIBE2 studies that compared upfront FOLFOXIRI + bevacizumab to FOLFIRI or FOLFOX + bevacizumab, respectively, were included. We assessed the association of primary tumor resection (PTR) with progression-free survival (PFS), overall survival (OS), response rate (ORR), rate of grade > 2 adverse events (AEs), and serious gastrointestinal and surgical AEs in the overall population and according to the treatment arm. RESULTS Of the 999 patients included, 513 (51%) underwent PTR at baseline. Longer PFS and OS were observed in resected patients compared to those with unresected primary tumors: 11.2 vs. 10.0 months (p < 0.001) and 26.6 vs. 22.5 (p < 0.001), respectively. In multivariate models, PTR was confirmed as an independent prognostic factor for better PFS (p = 0.032) and OS (p = 0.018). Patients with PTR experienced a higher incidence of grade 3 or 4 diarrhea (p = 0.055) and lower incidence of anemia (p = 0.053), perforation (p = 0.015), and serious gastrointestinal and surgical AEs (p < 0.001). No statistically significant differences were noted in incidence of bleeding (p = 0.39). The benefit of FOLFOXIRI + bevacizumab in terms of PFS (p for interaction: 0.46), OS (p for interaction: 0.80), ORR (p for interaction: 0.36), and incidence of grade 3 or 4 AEs was independent of PTR. CONCLUSIONS PTR at baseline was independently associated with good prognosis in synchronous mCRC patients and with lower incidence of serious gastrointestinal and surgical AEs during upfront chemotherapy plus bevacizumab. The benefit and toxicity profile of FOLFOXIRI plus bevacizumab was independent of PTR.
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Affiliation(s)
- Valentina Fanotto
- Department of Oncology, Academic Hospital of Udine, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), 33100 Udine, Italy; (V.F.); (M.C.); (N.P.)
| | - Daniele Rossini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Savi 10, 56126 Pisa, Italy; (D.R.); (C.A.); (G.V.); (B.B.); (M.C.); (V.C.); (G.M.)
- UO Oncologia 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy
| | - Mariaelena Casagrande
- Department of Oncology, Academic Hospital of Udine, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), 33100 Udine, Italy; (V.F.); (M.C.); (N.P.)
| | - Francesca Bergamo
- Medical Oncology 1, Veneto Institute of Oncology IOV—IRCCS, 35128 Padua, Italy; (F.B.); (F.D.)
| | - Andrea Spagnoletti
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, 20133 Milan, Italy; (A.S.); (V.N.)
| | - Daniele Santini
- Medical Oncology Unit A, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy;
| | - Carlotta Antoniotti
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Savi 10, 56126 Pisa, Italy; (D.R.); (C.A.); (G.V.); (B.B.); (M.C.); (V.C.); (G.M.)
- UO Oncologia 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy
| | - Samanta Cupini
- Department of Oncology, Division of Medical Oncology, Azienda USL Toscana Nord Ovest, 57124 Livorno, Italy;
| | - Francesca Daniel
- Medical Oncology 1, Veneto Institute of Oncology IOV—IRCCS, 35128 Padua, Italy; (F.B.); (F.D.)
| | - Vincenzo Nasca
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Dei Tumori, 20133 Milan, Italy; (A.S.); (V.N.)
| | - Guglielmo Vetere
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Savi 10, 56126 Pisa, Italy; (D.R.); (C.A.); (G.V.); (B.B.); (M.C.); (V.C.); (G.M.)
- UO Oncologia 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy
| | - Alberto Zaniboni
- Oncology Department, Istituto Ospedaliero Fondazione Poliambulanza, 25124 Brescia, Italy;
| | - Beatrice Borelli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Savi 10, 56126 Pisa, Italy; (D.R.); (C.A.); (G.V.); (B.B.); (M.C.); (V.C.); (G.M.)
- UO Oncologia 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy
| | - Martina Carullo
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Savi 10, 56126 Pisa, Italy; (D.R.); (C.A.); (G.V.); (B.B.); (M.C.); (V.C.); (G.M.)
- UO Oncologia 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy
| | - Veronica Conca
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Savi 10, 56126 Pisa, Italy; (D.R.); (C.A.); (G.V.); (B.B.); (M.C.); (V.C.); (G.M.)
- UO Oncologia 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy
| | - Alessandro Passardi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy;
| | - Emiliano Tamburini
- Oncology Department and Palliative Care, Cardinale Panico Tricase City Hospital, 73039 Tricase, Italy;
| | - Gianluca Masi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Savi 10, 56126 Pisa, Italy; (D.R.); (C.A.); (G.V.); (B.B.); (M.C.); (V.C.); (G.M.)
- UO Oncologia 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy
| | - Nicoletta Pella
- Department of Oncology, Academic Hospital of Udine, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), 33100 Udine, Italy; (V.F.); (M.C.); (N.P.)
| | - Chiara Cremolini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Savi 10, 56126 Pisa, Italy; (D.R.); (C.A.); (G.V.); (B.B.); (M.C.); (V.C.); (G.M.)
- UO Oncologia 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy
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Adebayo AS, Agbaje K, Adesina SK, Olajubutu O. Colorectal Cancer: Disease Process, Current Treatment Options, and Future Perspectives. Pharmaceutics 2023; 15:2620. [PMID: 38004598 PMCID: PMC10674471 DOI: 10.3390/pharmaceutics15112620] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/28/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023] Open
Abstract
Colorectal cancer (CRC) is one of the deadliest malignancies in the US, ranking fourth after lung, prostate, and breast cancers, respectively, in general populations. It continues to be a menace, and the incidence has been projected to more than double by 2035, especially in underdeveloped countries. This review seeks to provide some insights into the disease progression, currently available treatment options and their challenges, and future perspectives. Searches were conducted in the PubMed search engine in the university's online library. The keywords were "Colorectal Cancer" AND "disease process" OR "disease mechanisms" OR "Current Treatment" OR "Prospects". Selection criteria were original articles published primarily during the period of 2013 through 2023. Abstracts, books and documents, and reviews/systematic reviews were filtered out. Of over 490 thousand articles returned, only about 800 met preliminary selection criteria, 200 were reviewed in detail, but 191 met final selection criteria. Fifty-one other articles were used due to cross-referencing. Although recently considered a disease of lifestyle, CRC incidence appears to be rising in countries with low, low-medium, and medium social demographic indices. CRC can affect all parts of the colon and rectum but is more fatal with poor disease outcomes when it is right-sided. The disease progression usually takes between 7-10 years and can be asymptomatic, making early detection and diagnosis difficult. The CRC tumor microenvironment is made up of different types of cells interacting with each other to promote the growth and proliferation of the tumor cells. Significant advancement has been made in the treatment of colorectal cancer. Notable approaches include surgery, chemotherapy, radiation therapy, and cryotherapy. Chemotherapy, including 5-fluorouracil, irinotecan, oxaliplatin, and leucovorin, plays a significant role in the management of CRC that has been diagnosed at advanced stages. Two classes of monoclonal antibody therapies have been approved by the FDA for the treatment of colorectal cancer: the vascular endothelial growth factor (VEGF) inhibitor, e.g., bevacizumab (Avastin®), and the epidermal growth factor receptor (EGFR) inhibitor, e.g., cetuximab (Erbitux®) and panitumumab (Verbitix®). However, many significant problems are still being experienced with these treatments, mainly off-target effects, toxic side effects, and the associated therapeutic failures of small molecular drugs and the rapid loss of efficacy of mAb therapies. Other novel delivery strategies continue to be investigated, including ligand-based targeting of CRC cells.
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Affiliation(s)
- Amusa S. Adebayo
- College of Pharmacy, Howard University, 2400 6th St NW, Washington, DC 20059, USA; (K.A.); (S.K.A.); (O.O.)
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Takamoto T, Nara S, Ban D, Mizui T, Murase Y, Esaki M, Shimada K, Hashimoto T, Makuuchi M. Objective Definition and Optimized Strategy for "Biologically Borderline Resectable" Colorectal Liver Metastases. World J Surg 2023; 47:2834-2845. [PMID: 37540268 DOI: 10.1007/s00268-023-07133-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND The prognostic benefit of preoperative chemotherapy leading to conversion surgery for unresectable colorectal liver metastases (CRLM) is well recognized, while that of neoadjuvant chemotherapy (NAC) compared with upfront surgery (UFS) for resectable CRLM is negligible. This study aims to assess the prognostic benefit and search for optimal indication of NAC for resectable advanced CRLM by establishing an objective definition of biologically borderline resectable (bBR) CRLM. METHODS A bicentric retrospective analysis of patients with CRLM undergoing curative-intent initial liver resection between 2007 and 2021 was performed. An original classification matrix was established, which reassessed technical resectability using virtual hepatectomy and oncological favorability using Beppu's nomogram. Patients with technically resectable but biologically unfavorable CRLM were classified into the bBR group. The propensity score matching analysis using preoperatively available factors was performed to assess long-term outcomes of the bBR-UFS and bBR-NAC groups. RESULTS Of 831 patients reviewed, 240 were categorized into the bBR group: bBR -UFS (n = 139) and bBR-NAC (n = 101). Ten (10%) in the bBR-NAC group (n = 101) experienced biological status change from unfavorable to favorable after NAC (Biological Conversion) and showed significantly longer overall survival (hazard ratio 5.63, 95% confidence interval 1.37-23.1; P = 0.016) than the bBR-UFS group. However, after propensity score matching, no significant difference between the UFS and NAC groups (n = 67 for each) was found in long-term outcomes. CONCLUSIONS NAC for bBR-CRLM did not enhance the prognostic impact of the following liver resection, except for a limited number of optimal candidates experiencing the Biological Conversion.
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Affiliation(s)
- Takeshi Takamoto
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan.
| | - Satoshi Nara
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Daisuke Ban
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Takahiro Mizui
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Yoshiki Murase
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Minoru Esaki
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Kazuaki Shimada
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Takuya Hashimoto
- Division of Hepato-Biliary-Pancreatic and Transplantation Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Masatoshi Makuuchi
- Division of Hepato-Biliary-Pancreatic and Transplantation Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
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Inci K, Nilsson B, Lindskog S, Giglio D. Palliative resection of the primary tumour improves survival in incurable metastatic colorectal cancer. ANZ J Surg 2023; 93:2680-2685. [PMID: 37489624 DOI: 10.1111/ans.18629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 06/16/2023] [Accepted: 07/16/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Studies show conflicting results on whether primary tumour resection (PTR) in metastatic colorectal cancer (mCRC) prolongs survival. The aim of this study was to analyse prognostic factors and the effects of PTR on overall survival (OS) in mCRC patients. METHODS In this population-based cohort study, factors associated with PTR and OS were assessed in 188 mCRC patients with mCRC treated with palliative chemotherapy between 2008 and 2019. The Chi-square test and Mann-Whitney U-test were used to assess factors associated with PTR. The log-rank test was used to compare Kaplan-Meier estimates for OS. Cox regression was used to identify factors predicting OS. RESULTS Patients undergoing PTR had significantly better performance status, fewer metastatic sites, lower CEA levels, and more often had left-sided CRC than patients not undergoing PTR. OS was longer in palliative mCRC patients undergoing PTR (P < 0.01) and PTR was an independent variable in the Cox regression analysis (P < 0.05). Median OS was 22.9 ± 1.9 months for the PTR group and 14.5 ± 1.5 months for the non-operated group. Poor performance status and liver metastases were significantly associated with poor prognosis. CONCLUSION This study shows that PTR had a positive effect on OS and may be considered in patients suitable for surgery. PTR was offered to palliative mCRC patients with prognostic factors associated with better prognosis.
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Affiliation(s)
- Kamuran Inci
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Region Halland, Varberg, Sweden
| | - Bengt Nilsson
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Region Halland, Varberg, Sweden
| | - Stefan Lindskog
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Daniel Giglio
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Ruan D, Wang J, Ding T, Chen L, Du Y, Ruan Y, Cui W, Feng W. Targeting Adhesive Tumor Adventitia via Injectable Electrospun Short Fibers in Perfusion of Intraperitoneal Sporadic Tumors. SMALL METHODS 2023; 7:e2300681. [PMID: 37670530 DOI: 10.1002/smtd.202300681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/21/2023] [Indexed: 09/07/2023]
Abstract
Intraperitoneal sporadic tumor is a common and complicated syndrome in cancers, causing a high rate of death, and people find that intraperitoneal chemotherapy (IPC) can treat intraperitoneal sporadic tumors better than intravenous chemotherapy and surgery. However, the effectiveness and side effects of IPC are controversial, and the operation process of IPC is complicated. Herein, the injectable paclitaxel-loaded (PTX-loaded) electrospun short fibers are constructed through a series process of electrospinning, homogenizing, crosslinking, and subsequent polydopamine coating and folate acid (FA) modification. The evenly dispersed short fibers exhibited effective tumor cell killing and good injectable ability, which is convenient to use and greatly improved the complex operation procedure. Mussel-like protein poly-dopamine coating and FA modification endowed short fibers with the ability of targeted adhesion to tumors, and therefore the short fibers further acted as a kind of micro membrane that could release drugs to tumors at close range, maintaining local high drug concentration and prevent paclitaxel killing normal tissues. Thus, the target-adhesive injectable electrospun short fibers are expected to be the potential candidate for cancer treatment, especially the intraperitoneal sporadic tumors, which are hard to treat by surgery or intravenous chemotherapy.
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Affiliation(s)
- Dan Ruan
- Department of Gynecology and Obstetrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
| | - Juan Wang
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
| | - Tao Ding
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
| | - Liang Chen
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
| | - Yawei Du
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
| | - Yiyin Ruan
- Department of Gynecology and Obstetrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
| | - Wenguo Cui
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
| | - Weiwei Feng
- Department of Gynecology and Obstetrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
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Okui J, Shigeta K, Kato Y, Mizuno S, Sugiura K, Seo Y, Nakadai J, Baba H, Kikuchi H, Hirata A, Makino A, Kondo T, Matsui S, Seishima R, Okabayashi K, Obara H, Sato Y, Kitagawa Y. Delayed-Onset Organ/Space Surgical Site Infection Worsens Prognosis in High-Risk Stage II and III Colorectal Cancer. J Gastrointest Surg 2023; 27:2515-2525. [PMID: 37740145 DOI: 10.1007/s11605-023-05836-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 08/31/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND It is unclear how early- and delayed-onset organ/space surgical site infections (SSIs) affect the long-term prognosis of patients with colorectal cancer, who are potential candidates for adjuvant chemotherapy. This study aimed to investigate the association between the timing of SSI onset and clinical outcome. METHODS This retrospective, multicenter cohort study evaluated patients who were diagnosed with high-risk stage II or III colorectal cancer and underwent elective surgery between 2010 and 2020. Five-year recurrence-free survival (RFS) was the primary endpoint and was compared between early SSI, delayed SSI (divided based on the median date of SSI onset), and non-SSI groups. RESULTS A total of 2,065 patients were included. Organ/space SSI was diagnosed in 91 patients (4.4%), with a median onset of 6 days after surgery. The early-onset SSI group had a higher proportion of patients with Clavien-Dindo grade ≥IIIb SSI than the delayed-onset SSI. Patients who received adjuvant chemotherapy (AC) had earlier organ/space SSI onset than those who did not. The adjusted hazard ratio of 5-year RFS in the delayed-onset SSI was 2.58 (95% confidence interval: 1.43-4.65; p = 0.002): higher than that in the early-onset SSI, with the non-SSI as the reference. CONCLUSIONS Delayed-onset organ/space SSI worsened long-term prognosis compared to early-onset, and this may be due to delayed initiation of AC. Patients who are clinically suspected of having lymph node metastasis might need additional intervention to prevent delays in commencing AC due to the delayed SSI.
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Affiliation(s)
- Jun Okui
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Kohei Shigeta
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
| | - Yujin Kato
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Shodai Mizuno
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kiyoaki Sugiura
- Department of Surgery, Japan Red Cross Ashikaga Hospital, Tochigi, Japan
| | - Yuki Seo
- Department of Surgery, Japan Red Cross Ashikaga Hospital, Tochigi, Japan
| | - Jumpei Nakadai
- Department of Gastrointestinal Surgery, Saitama City Hospital, Saitama, Japan
| | - Hideo Baba
- Department of Gastrointestinal Surgery, Saitama City Hospital, Saitama, Japan
| | - Hiroto Kikuchi
- Department of Surgery, Hiratsuka City Hospital, Hiratsuka, Kanagawa, Japan
| | - Akira Hirata
- Department of Surgery, Hiratsuka City Hospital, Hiratsuka, Kanagawa, Japan
| | - Akitsugu Makino
- Department of Surgery, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Takayuki Kondo
- Department of Surgery, Kawasaki Municipal Hospital, Kawasaki, Kanagawa, Japan
| | - Shimpei Matsui
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Ryo Seishima
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Koji Okabayashi
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hideaki Obara
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
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Shin JE, An HJ, Shim BY, Kim H, Park HS, Cho HM, Kye BH, Yoo RN, Moon JY, Kim SH, Lee J, Lee HC, Jung JH, Lee KM, Lee JM. Clinical Outcomes of Upfront Primary Tumor Resection in Synchronous Unresectable Metastatic Colorectal Cancer. Cancers (Basel) 2023; 15:5057. [PMID: 37894424 PMCID: PMC10605032 DOI: 10.3390/cancers15205057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/01/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
The role of upfront primary tumor resection (PTR) in patients with unresectable metastatic colorectal cancer without severe symptoms remains controversial. We retrospectively analyzed the role of PTR in overall survival (OS) in this population. Among the 205 patients who enrolled, the PTR group (n = 42) showed better performance (p = 0.061), had higher frequencies of right-sided origin (p = 0.058), the T4 stage (p = 0.003), the M1a stage (p = 0.012), and <2 organ metastases (p = 0.002), and received fewer targeted agents (p = 0.011) than the chemotherapy group (n = 163). The PTR group showed a trend for longer OS (20.5 versus 16.0 months, p = 0.064) but was not related to OS in Cox regression multivariate analysis (p = 0.220). The male sex (p = 0.061), a good performance status (p = 0.078), the T3 stage (p = 0.060), the M1a stage (p = 0.042), <2 organ metastases (p = 0.035), an RAS wild tumor (p = 0.054), and the administration of targeted agents (p = 0.037), especially bevacizumab (p = 0.067), seemed to be related to PTR benefits. Upfront PTR could be considered beneficial in some subgroups, but these findings require larger studies to verify.
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Affiliation(s)
- Ji Eun Shin
- Division of Oncology, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Republic of Korea; (J.E.S.); (B.Y.S.); (H.K.); (H.S.P.)
| | - Ho Jung An
- Division of Oncology, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Republic of Korea; (J.E.S.); (B.Y.S.); (H.K.); (H.S.P.)
| | - Byoung Yong Shim
- Division of Oncology, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Republic of Korea; (J.E.S.); (B.Y.S.); (H.K.); (H.S.P.)
| | - Hyunho Kim
- Division of Oncology, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Republic of Korea; (J.E.S.); (B.Y.S.); (H.K.); (H.S.P.)
| | - Hyung Soon Park
- Division of Oncology, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Republic of Korea; (J.E.S.); (B.Y.S.); (H.K.); (H.S.P.)
| | - Hyeon-Min Cho
- Department of Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Republic of Korea; (H.-M.C.); (B.-H.K.); (R.N.Y.); (J.-Y.M.)
| | - Bong-Hyeon Kye
- Department of Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Republic of Korea; (H.-M.C.); (B.-H.K.); (R.N.Y.); (J.-Y.M.)
| | - Ri Na Yoo
- Department of Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Republic of Korea; (H.-M.C.); (B.-H.K.); (R.N.Y.); (J.-Y.M.)
| | - Ji-Yeon Moon
- Department of Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Republic of Korea; (H.-M.C.); (B.-H.K.); (R.N.Y.); (J.-Y.M.)
| | - Sung Hwan Kim
- Department of Radiation Oncology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Republic of Korea; (S.H.K.); (J.L.); (H.C.L.)
| | - Jonghoon Lee
- Department of Radiation Oncology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Republic of Korea; (S.H.K.); (J.L.); (H.C.L.)
| | - Hyo Chun Lee
- Department of Radiation Oncology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Republic of Korea; (S.H.K.); (J.L.); (H.C.L.)
| | - Ji-Han Jung
- Department of Hospital Pathology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Republic of Korea;
| | - Kang-Moon Lee
- Division of Gastroenterology, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Republic of Korea; (K.-M.L.); (J.M.L.)
| | - Ji Min Lee
- Division of Gastroenterology, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon 16247, Republic of Korea; (K.-M.L.); (J.M.L.)
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Stålberg P. Metastatic small-bowel neuroendocrine tumours: medical management of the primary. Br J Surg 2023; 110:1296-1297. [PMID: 37527436 DOI: 10.1093/bjs/znad248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/14/2023] [Accepted: 07/14/2023] [Indexed: 08/03/2023]
Affiliation(s)
- Peter Stålberg
- Department of Surgical Sciences, Endocrine Surgical Unit, Uppsala University Hospital, Uppsala, Sweden
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37
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Howe JR. Metastatic small bowel neuroendocrine tumours: surgical management of the primary. Br J Surg 2023; 110:1293-1295. [PMID: 37566464 DOI: 10.1093/bjs/znad247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 08/13/2023]
Affiliation(s)
- James R Howe
- Surgical Oncology and Endocrine Surgery, Roy J. and Lucille A. Carver University of Iowa College of Medicine, Iowa City, Iowa, USA
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Fernández Montes A, Alonso V, Aranda E, Élez E, García Alfonso P, Grávalos C, Maurel J, Vera R, Vidal R, Aparicio J. SEOM-GEMCAD-TTD clinical guidelines for the systemic treatment of metastatic colorectal cancer (2022). Clin Transl Oncol 2023; 25:2718-2731. [PMID: 37133732 PMCID: PMC10425293 DOI: 10.1007/s12094-023-03199-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 04/10/2023] [Indexed: 05/04/2023]
Abstract
Colorectal cancer (CRC) is the second leading cause of cancer deaths in Spain. Metastatic disease is present in 15-30% of patients at diagnosis and up to 20-50% of those with initially localized disease eventually develop metastases. Recent scientific knowledge acknowledges that this is a clinically and biologically heterogeneous disease. As treatment options increase, prognosis for individuals with metastatic disease has steadily improved over recent decades. Disease management should be discussed among experienced, multidisciplinary teams to select the most appropriate systemic treatment (chemotherapy and targeted agents) and to integrate surgical or ablative procedures, when indicated. Clinical presentation, tumor sidedness, molecular profile, disease extension, comorbidities, and patient preferences are key factors when designing a customized treatment plan. These guidelines seek to provide succinct recommendations for managing metastatic CRC.
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Affiliation(s)
- Ana Fernández Montes
- Medical Oncology Department, Complexo Hospitalario Universitario, Ourense (CHUO), C/ Ramón Puga, 56, 32005 Ourense, Spain
| | - Vicente Alonso
- Medical Oncology Department, Hospital Universitario Miguel Servet, Saragossa, Spain
| | - Enrique Aranda
- Medical Oncology Department, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Elena Élez
- Medical Oncology Department, Hospital Universitario Vall D’Hebron, Barcelona, Spain
| | - Pilar García Alfonso
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Cristina Grávalos
- Medical Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Joan Maurel
- Medical Oncology Department, Hospital Clínic, Barcelona, Spain
| | - Ruth Vera
- Medical Oncology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Rosario Vidal
- Medical Oncology Department, Complejo Asistencial Universitario, Salamanca, Spain
| | - Jorge Aparicio
- Medical Oncology Department, Hospital Universitari I Politècnic la Fe, Valencia, Spain
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Siriwardena AK, Serrablo A, Fretland ÅA, Wigmore SJ, Ramia-Angel JM, Malik HZ, Stättner S, Søreide K, Zmora O, Meijerink M, Kartalis N, Lesurtel M, Verhoef C, Balakrishnan A, Gruenberger T, Jonas E, Devar J, Jamdar S, Jones R, Hilal MA, Andersson B, Boudjema K, Mullamitha S, Stassen L, Dasari BVM, Frampton AE, Aldrighetti L, Pellino G, Buchwald P, Gürses B, Wasserberg N, Gruenberger B, Spiers HVM, Jarnagin W, Vauthey JN, Kokudo N, Tejpar S, Valdivieso A, Adam R. The multi-societal European consensus on the terminology, diagnosis and management of patients with synchronous colorectal cancer and liver metastases: an E-AHPBA consensus in partnership with ESSO, ESCP, ESGAR, and CIRSE. HPB (Oxford) 2023; 25:985-999. [PMID: 37471055 DOI: 10.1016/j.hpb.2023.05.360] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 05/13/2023] [Accepted: 05/16/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Contemporary management of patients with synchronous colorectal cancer and liver metastases is complex. The aim of this project was to provide a practical framework for care of patients with synchronous colorectal cancer and liver metastases with a focus on terminology, diagnosis and management. METHODS This project was a multi-organisational, multidisciplinary consensus. The consensus group produced statements which focused on terminology, diagnosis and management. Statements were refined during an online Delphi process and those with 70% agreement or above were reviewed at a final meeting. Iterations of the report were shared by electronic mail to arrive at a final agreed document comprising twelve key statements. RESULTS Synchronous liver metastases are those detected at the time of presentation of the primary tumour. The term "early metachronous metastases" applies to those absent at presentation but detected within 12 months of diagnosis of the primary tumour with "late metachronous metastases" applied to those detected after 12 months. Disappearing metastases applies to lesions which are no longer detectable on MR scan after systemic chemotherapy. Guidance was provided on the recommended composition of tumour boards and clinical assessment in emergency and elective settings. The consensus focused on treatment pathways including systemic chemotherapy, synchronous surgery and the staged approach with either colorectal or liver-directed surgery as first step. Management of pulmonary metastases and the role of minimally invasive surgery was discussed. CONCLUSIONS The recommendations of this contemporary consensus provide information of practical value to clinicians managing patients with synchronous colorectal cancer and liver metastases.
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Affiliation(s)
| | - Alejandro Serrablo
- Department of Surgery, Miguel Servet University Hospital, Zaragoza, Spain
| | | | - Stephen J Wigmore
- Hepatobiliary and Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Jose M Ramia-Angel
- Department of Surgery, University Hospital of Guadalajara, Guadalajara, Spain
| | - Hassan Z Malik
- Liver Surgery Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Stefan Stättner
- Department of General, Visceral and Vascular Surgery, Salzkammergutklinikum, Vöcklabruck, Austria
| | - Kjetil Søreide
- Department of Surgery, Bergen University Hospital, Bergen, Norway
| | - Oded Zmora
- Department of Colorectal Surgery, Shamir Medical Center, Tel Aviv, Israel
| | - Martijn Meijerink
- Department of Radiology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | | | | | - Cornelis Verhoef
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Anita Balakrishnan
- Cambridge Hepato-Pancreato-Biliary Unit, Addenbrooke's Hospital, Cambridge, UK
| | - Thomas Gruenberger
- Department of Surgery, HPB Center, Health Network Vienna, Clinic Favoriten and Sigmund Freud University, Vienna, Austria
| | - Eduard Jonas
- Department of Surgery, Groote Schuur Hospital, Cape Town
| | - John Devar
- Department of Surgery, Chris Hani Baragwanath Hospital, Johannesburg, South Africa
| | - Saurabh Jamdar
- Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Manchester, UK
| | - Robert Jones
- Liver Surgery Unit, Royal Liverpool University Hospital, Liverpool, UK
| | | | - Bodil Andersson
- Department of Surgery, Skane University Hospital, Lund, Sweden
| | - Karim Boudjema
- Department of Hepatobiliary, Pancreatic and Digestive Surgery, Hôpital Pontchaillou, Rennes, France
| | | | - Laurents Stassen
- Department of Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Bobby V M Dasari
- Hepatobiliary and Liver Transplant Unit, Queen Elizabeth University Hospital, Birmingham, UK
| | - Adam E Frampton
- Hepato-Pancreato-Biliary Unit, Royal Surrey County Hospital, Guildford, UK
| | - Luca Aldrighetti
- Department of Surgery, Vita Salute San Raffaele University & IRCCS San Raffaele Hospital, Milan, Italy
| | - Gianluca Pellino
- Department of Colorectal Surgery, Vall D'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain; Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Pamela Buchwald
- Department of Surgery, Skane University Hospital, Lund, Sweden
| | - Bengi Gürses
- Department of Radiology, Koc University Medical Faculty, Istanbul, Turkey
| | - Nir Wasserberg
- Department of Surgery, Beilinson Hospital, Rabin Medical Center, Tel Aviv University, Israel
| | - Birgit Gruenberger
- Department of Medical Oncology and Haematology, Landesklinikum Wiener Neustadt, Lower Austria, Austria
| | - Harry V M Spiers
- Cambridge Hepato-Pancreato-Biliary Unit, Addenbrooke's Hospital, Cambridge, UK
| | - William Jarnagin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | | | - Norihiro Kokudo
- Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | | | | | - René Adam
- Hepatobiliary and Transplant Unit, Hôpital Paul Brousse, Paris, France
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Lin Q, Ding K, Zhao R, Wang H, Wei Y, Ren L, Ye Q, Cui Y, He G, Tang W, Feng Q, Zhu D, Chang W, Wang X, Liang L, Zhou G, Liang F, Ye F, Wang J, Fan J, Xu J. Preoperative chemotherapy prior to primary tumour resection for asymptomatic synchronous unresectable colorectal liver-limited metastases: The RECUT multicenter randomised controlled trial. Eur J Cancer 2023; 191:112961. [PMID: 37473466 DOI: 10.1016/j.ejca.2023.112961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/14/2023] [Accepted: 06/20/2023] [Indexed: 07/22/2023]
Abstract
PURPOSE Primary tumour resection (PTR) is still a selection for patients with low tumour burden and good condition, especially with conversion therapy purpose for colorectal liver-limited metastases (CRLMs). The objective was to evaluate whether pre-PTR chemotherapy could improve progression-free survival (PFS) for patients with asymptomatic synchronous unresectable CRLMs. PATIENTS AND METHODS Patients with asymptomatic synchronous unresectable CRLMs were randomly assigned to receive pre-PTR chemotherapy (arm A) or upfront PTR (arm B). Chemotherapy regimens of mFOLFOX6 plus cetuximab, mFOLFOX6 plus bevacizumab or mFOLFOX6 alone were chosen according to the RAS genotype. The primary end-point was PFS; secondary end-points included overall survival (OS), tumour response, disease control rate (DCR), liver metastases resection rate, surgical complications and chemotherapy toxicity. RESULTS Three hundred and twenty patients were randomly assigned to arm A (160 patients) and arm B (160 patients). Patients in arm A had significantly improved the median PFS compared with arm B (10.5 versus 9.1 months; P = 0.013). Patients in arm A also had significantly better DCR (84.4% versus 75.0%; P = 0.037). The median OS (29.4 versus 27.2 months; P = 0.058), objective response rate (ORR) (53.1% versus 45.0%; P = 0.146) and liver metastases resection rate (21.9% versus 18.1%; P = 0.402) were not significantly different. The Clavien-Dindo 3-4 complications post PTR (4.5% versus 3.8%, P = 0.759) and the incidence of grade 3/4 chemotherapy events (42.2% versus 40.4%, P = 0.744) reached no statistical significance. CONCLUSIONS For asymptomatic synchronous unresectable CRLMs, Pre-PTR chemotherapy improved the PFS compared with upfront PTR.
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Affiliation(s)
- Qi Lin
- Department of Colorectal Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive Technology, Cancer Center Zhongshan Hospital, Fudan University, Shanghai, China; Cancer Center Zhongshan Hospital, Shanghai, China
| | - Kefeng Ding
- Department of Colorectal Surgery and Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Ren Zhao
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hao Wang
- Department of Colorectal Surgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Ye Wei
- Department of Colorectal Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive Technology, Cancer Center Zhongshan Hospital, Fudan University, Shanghai, China; Cancer Center Zhongshan Hospital, Shanghai, China
| | - Li Ren
- Department of Colorectal Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive Technology, Cancer Center Zhongshan Hospital, Fudan University, Shanghai, China; Cancer Center Zhongshan Hospital, Shanghai, China
| | - Qinghai Ye
- Cancer Center Zhongshan Hospital, Shanghai, China; Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuehong Cui
- Cancer Center Zhongshan Hospital, Shanghai, China; Department of Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guodong He
- Department of Colorectal Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive Technology, Cancer Center Zhongshan Hospital, Fudan University, Shanghai, China; Cancer Center Zhongshan Hospital, Shanghai, China
| | - Wentao Tang
- Department of Colorectal Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive Technology, Cancer Center Zhongshan Hospital, Fudan University, Shanghai, China; Cancer Center Zhongshan Hospital, Shanghai, China
| | - Qingyang Feng
- Department of Colorectal Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive Technology, Cancer Center Zhongshan Hospital, Fudan University, Shanghai, China; Cancer Center Zhongshan Hospital, Shanghai, China
| | - Dexiang Zhu
- Department of Colorectal Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive Technology, Cancer Center Zhongshan Hospital, Fudan University, Shanghai, China; Cancer Center Zhongshan Hospital, Shanghai, China
| | - Wenju Chang
- Department of Colorectal Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive Technology, Cancer Center Zhongshan Hospital, Fudan University, Shanghai, China; Cancer Center Zhongshan Hospital, Shanghai, China
| | - Xiaoying Wang
- Cancer Center Zhongshan Hospital, Shanghai, China; Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Li Liang
- Cancer Center Zhongshan Hospital, Shanghai, China; Department of Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guofeng Zhou
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Fei Liang
- Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Feng Ye
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianwei Wang
- Department of Colorectal Surgery and Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Jia Fan
- Cancer Center Zhongshan Hospital, Shanghai, China; Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jianmin Xu
- Department of Colorectal Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive Technology, Cancer Center Zhongshan Hospital, Fudan University, Shanghai, China; Cancer Center Zhongshan Hospital, Shanghai, China.
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Maki H, Ayabe RI, Nishioka Y, Konishi T, Newhook TE, Tran Cao HS, Chun YS, Tzeng CWD, You YN, Vauthey JN. Hepatectomy Before Primary Tumor Resection as Preferred Approach for Synchronous Liver Metastases from Rectal Cancer. Ann Surg Oncol 2023; 30:5390-5400. [PMID: 37285096 DOI: 10.1245/s10434-023-13656-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/02/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND For patients with synchronous liver metastases (LM) from rectal cancer, a consensus on surgical sequencing is lacking. We compared outcomes between the reverse (hepatectomy first), classic (primary tumor resection first), and combined (simultaneous hepatectomy and primary tumor resection) approaches. METHODS A prospectively maintained database was queried for patients with rectal cancer LM diagnosed before primary tumor resection who underwent hepatectomy for LM from January 2004 to April 2021. Clinicopathological factors and survival were compared between the three approaches. RESULTS Among 274 patients, 141 (51%) underwent the reverse approach; 73 (27%), the classic approach; and 60 (22%), the combined approach. Higher carcinoembryonic antigen level at LM diagnosis and higher number of LM were associated with the reverse approach. Combined approach patients had smaller tumors and underwent less complex hepatectomies. More than eight cycles of pre-hepatectomy chemotherapy and maximum diameter of LM > 5 cm were independently associated with worse overall survival (OS) (p = 0.002 and 0.027, respectively). Although 35% of reverse-approach patients did not undergo primary tumor resection, OS did not differ between groups. Additionally, 82% of incomplete reverse-approach patients ultimately did not require diversion during follow-up. RAS/TP53 co-mutation was independently associated with lack of primary resection with the reverse approach (odds ratio: 0.16, 95% CI 0.038-0.64, p = 0.010). CONCLUSIONS The reverse approach results in survival similar to that of combined and classic approaches and may obviate primary rectal tumor resections and diversions. RAS/TP53 co-mutation is associated with a lower rate of completion of the reverse approach.
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Affiliation(s)
- Harufumi Maki
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Reed I Ayabe
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yujiro Nishioka
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tsuyoshi Konishi
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Timothy E Newhook
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hop S Tran Cao
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yun Shin Chun
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ching-Wei D Tzeng
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Y Nancy You
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
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Li S, Ji L, Huang J, Wang Y, Liu P, Zhang W, Lou Z. The impact of primary tumor resection for asymptomatic colorectal cancer patients with unresectable metastases: a systematic review and meta-analysis. Int J Colorectal Dis 2023; 38:214. [PMID: 37581775 DOI: 10.1007/s00384-023-04500-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Whether patients with asymptomatic primary tumors and unresectable metastases of colorectal cancer (CRC) should undergo primary tumor resection (PTR) remains controversial. This study aims to determine the appropriateness of PTR for these individuals by evaluating a number of outcome measures. METHODS A systematic literature search was performed. Outcome measures included overall survival, emergency surgery rates, incidence of postoperative complications, time to initiate chemotherapy, conversion rates, and chemotherapy-related toxicities. RESULTS Patients who received PTR in addition to chemotherapy had a better overall survival rate than those who only received chemotherapy (HR = 0.62, 95%CI, 0.50-0.78, I2 = 84%, p < 0.00001). In the RCT subgroup, there were no significant differences with a HR of 0.72 (95%CI, 0.45-1.13, I2 = 17%, p = 0.15). More patients in the chemotherapy alone group could be converted to resectable status (OR = 0.47, 95%CI, 0.27-0.82, I2 = 0%, p = 0.008), but the incidence of emergency surgery was 23% (95%CI, 17-29%, I2 = 14%). The risk of chemotherapy-related toxicity was not significantly higher in the PTR group (OR = 1.5, 95%CI, 0.94-2.43, p = 0.09, I2 = 0%), with a 7% incidence of postoperative complications (95%CI, 0-14%, p = 0.05, I2 = 0%). The time to initiate chemotherapy after PTR was approximately 33.06 days (95%CI, 25.55-40.58, I2 = 0%). CONCLUSION PTR plus chemotherapy may be associated with improved survival in asymptomatic CRC patients with unresectable metastases. However, PTR did not provide a significant survival benefit in the subgroup of RCTs. Additionally, PTR did not result in a significantly increased risk of chemotherapy-related toxicity, with a postoperative complication rate of approximately 7%, and chemotherapy could be initiated at approximately 33.06 days after PTR. Compared with the PTR plus chemotherapy, chemotherapy alone could result in a significantly higher conversion rate. However, about 23% of patients receiving chemotherapy alone required emergency surgery for primary tumor-related symptoms. The above results needed to be validated in future larger prospective randomized trials.
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Affiliation(s)
- Shuyuan Li
- Department of Colorectal Surgery, the first affiliated Hospital of Naval Medical University, 168 Changhai Road, Yangpu District, Shanghai, China
| | - Liqiang Ji
- Department of Colorectal Surgery, the first affiliated Hospital of Naval Medical University, 168 Changhai Road, Yangpu District, Shanghai, China
| | - Jie Huang
- The first affiliated Hospital of Naval Medical University, Shanghai, China
| | - Ye Wang
- Department of Colorectal Surgery, the first affiliated Hospital of Naval Medical University, 168 Changhai Road, Yangpu District, Shanghai, China
| | - Peng Liu
- Department of Colorectal Surgery, the first affiliated Hospital of Naval Medical University, 168 Changhai Road, Yangpu District, Shanghai, China
| | - Wei Zhang
- Department of Colorectal Surgery, the first affiliated Hospital of Naval Medical University, 168 Changhai Road, Yangpu District, Shanghai, China
| | - Zheng Lou
- Department of Colorectal Surgery, the first affiliated Hospital of Naval Medical University, 168 Changhai Road, Yangpu District, Shanghai, China.
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Siriwardena AK, Serrablo A, Fretland ÅA, Wigmore SJ, Ramia-Angel JM, Malik HZ, Stättner S, Søreide K, Zmora O, Meijerink M, Kartalis N, Lesurtel M, Verhoef K, Balakrishnan A, Gruenberger T, Jonas E, Devar J, Jamdar S, Jones R, Hilal MA, Andersson B, Boudjema K, Mullamitha S, Stassen L, Dasari BVM, Frampton AE, Aldrighetti L, Pellino G, Buchwald P, Gürses B, Wasserberg N, Gruenberger B, Spiers HVM, Jarnagin W, Vauthey JN, Kokudo N, Tejpar S, Valdivieso A, Adam R. Multisocietal European consensus on the terminology, diagnosis, and management of patients with synchronous colorectal cancer and liver metastases: an E-AHPBA consensus in partnership with ESSO, ESCP, ESGAR, and CIRSE. Br J Surg 2023; 110:1161-1170. [PMID: 37442562 PMCID: PMC10416695 DOI: 10.1093/bjs/znad124] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 04/13/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Contemporary management of patients with synchronous colorectal cancer and liver metastases is complex. The aim of this project was to provide a practical framework for care of patients with synchronous colorectal cancer and liver metastases, with a focus on terminology, diagnosis, and management. METHODS This project was a multiorganizational, multidisciplinary consensus. The consensus group produced statements which focused on terminology, diagnosis, and management. Statements were refined during an online Delphi process, and those with 70 per cent agreement or above were reviewed at a final meeting. Iterations of the report were shared by electronic mail to arrive at a final agreed document comprising 12 key statements. RESULTS Synchronous liver metastases are those detected at the time of presentation of the primary tumour. The term 'early metachronous metastases' applies to those absent at presentation but detected within 12 months of diagnosis of the primary tumour, the term 'late metachronous metastases' applies to those detected after 12 months. 'Disappearing metastases' applies to lesions that are no longer detectable on MRI after systemic chemotherapy. Guidance was provided on the recommended composition of tumour boards, and clinical assessment in emergency and elective settings. The consensus focused on treatment pathways, including systemic chemotherapy, synchronous surgery, and the staged approach with either colorectal or liver-directed surgery as first step. Management of pulmonary metastases and the role of minimally invasive surgery was discussed. CONCLUSION The recommendations of this contemporary consensus provide information of practical value to clinicians managing patients with synchronous colorectal cancer and liver metastases.
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Affiliation(s)
| | - Alejandro Serrablo
- Department of Surgery, Miguel Servet University Hospital, Zaragoza, Spain
| | | | - Stephen J Wigmore
- Hepatobiliary and Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Hassan Z Malik
- Liver Surgery Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Stefan Stättner
- Department of General, Visceral and Vascular Surgery, Salzkammergutklinikum, Vöcklabruck, Austria
| | - Kjetil Søreide
- Department of Surgery, Bergen University Hospital, Bergen, Norway
| | - Oded Zmora
- Department of Colorectal Surgery, Shamir Medical Centre, Tel Aviv, Israel
| | - Martijn Meijerink
- Department of Radiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | | | | | - Kees Verhoef
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Anita Balakrishnan
- Cambridge Hepato-Pancreato-Biliary Unit, Addenbrooke’s Hospital, Cambridge, UK
| | - Thomas Gruenberger
- Department of Surgery, Hepatopancreatobiliary Centre, Health Network Vienna, Clinic Favoriten and Sigmund Freud University, Vienna, Austria
| | - Eduard Jonas
- Department of Surgery, Groote Schuur Hospital, Cape Town, South Africa
| | - John Devar
- Department of Surgery, Chris Hani Baragwanath Hospital, Johannesburg, South Africa
| | - Saurabh Jamdar
- Hepato-Pancreato-Biliary Unit, Manchester Royal Infirmary, Manchester, UK
| | - Robert Jones
- Liver Surgery Unit, Royal Liverpool University Hospital, Liverpool, UK
| | | | - Bodil Andersson
- Department of Surgery, Skane University Hospital, Lund, Sweden
| | - Karim Boudjema
- Department of Hepatobiliary, Pancreatic and Digestive surgery, Hôpital Pontchaillou, Rennes, France
| | | | - Laurents Stassen
- Department of Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Bobby V M Dasari
- Hepatobiliary and Liver Transplant Unit, Queen Elizabeth University Hospital, Birmingham, UK
| | - Adam E Frampton
- Hepato-Pancreato-Biliary Unit, Royal Surrey County Hospital, Guildford, UK
| | - Luca Aldrighetti
- Department of Surgery, Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital, Milan, Italy
| | - Gianluca Pellino
- Department of Colorectal Surgery, Vall d’Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Pamela Buchwald
- Department of Surgery, Skane University Hospital, Lund, Sweden
| | - Bengi Gürses
- Department of Radiology, Koc University Medical Faculty, Istanbul, Turkey
| | - Nir Wasserberg
- Department of Surgery, Beilinson Hospital, Rabin Medical Centre, Tel Aviv University, Tel Aviv, Israel
| | - Birgit Gruenberger
- Department of Medical Oncology and Haematology, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
| | - Harry V M Spiers
- Cambridge Hepato-Pancreato-Biliary Unit, Addenbrooke’s Hospital, Cambridge, UK
| | - William Jarnagin
- Department of Surgery, Memorial Sloan Kettering Cancer Centre, New York, New York, USA
| | | | - Norihiro Kokudo
- Department of Surgery, National Centre for Global Health and Medicine, Tokyo, Japan
| | | | - Andres Valdivieso
- Hepatopancreatobiliary Surgery and Liver Transplant, HU Cruces, Bilbao, Spain
| | - René Adam
- Hepatobiliary and Transplant Unit, Hôpital Paul Brousse, Paris, France
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Li Y, Cheng X, Zhong C, Yuan Y. Primary Tumor Resection Plus Chemotherapy versus Chemotherapy Alone for Colorectal Cancer Patients with Synchronous Bone Metastasis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1384. [PMID: 37629673 PMCID: PMC10456365 DOI: 10.3390/medicina59081384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/23/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023]
Abstract
Background and Objective: Colorectal cancer (CRC) bone metastasis (BM), particularly synchronous metastasis, is infrequent and has a poor prognosis. Radical surgery for CRC with BM is challenging, and chemotherapy is the standard treatment. However, it is unclear whether combining chemotherapy with primary tumor resection (PTR) yields greater survival benefits than chemotherapy alone, as no relevant reports exist. Material and Methods: The Surveillance, Epidemiology, and End Results (SEER) database provided data on 1662 CRC patients with bone metastasis between 2010 and 2018, who were divided into two groups: chemotherapy combined with PTR and chemotherapy alone. Survival distributions were compared using the log-rank test, and survival estimates were obtained using the Kaplan-Meier method. A Cox proportional multivariate regression analysis was conducted to estimate the survival benefit of chemotherapy combined with PTR while controlling for additional prognostic factors. Results: The chemotherapy only group consisted of 1277 patients (76.8%), while the chemotherapy combined with PTR group contained 385 patients (23.2%). Patients who received chemotherapy combined with PTR had a significantly higher 1-year survival rate (60.7%) and 2-year survival rate (32.7%) compared to those who only received chemotherapy (43.8% and 18.4%, respectively; p < 0.0001). Independent prognostic factors identified by Cox proportional analysis were age, location of the primary tumor, type of tumor, M stage, metastasectomy and PTR. Patients who received chemotherapy combined with PTR had a significantly improved prognosis (HR 0.586, 95% CI 0.497-0.691, p < 0.0001). All subgroups demonstrated a survival advantage for patients who received chemotherapy in combination with PTR. Conclusions: Our findings suggest that patients with BM from CRC may benefit from chemotherapy combined with PTR. Our analysis also identified age, location of the primary tumor, type of tumor, M stage, metastasectomy, and PTR as independent prognostic risk factors for CRC patients with synchronous BM.
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Affiliation(s)
- Yanqing Li
- Department of Pathology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China;
| | - Xiaofei Cheng
- Department of Colorectal Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China;
| | - Chenhan Zhong
- Department of Medical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China;
| | - Ying Yuan
- Department of Medical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China;
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He M, Jia Z, Hu L, Wu H. Development and validation of a nomogram to predict which patients with colorectal cancer liver metastases would benefit from primary tumor resection. Int J Colorectal Dis 2023; 38:144. [PMID: 37237238 DOI: 10.1007/s00384-023-04426-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 05/28/2023]
Abstract
PURPOSE The use of primary tumor resection (PTR) in the treatment of colorectal cancer liver metastases (CRLM) patients has become increasingly controversial. Our goal is to establish a nomogram to screen for the candidates that would benefit from PTR in CRLM patients. METHODS The Surveillance, Epidemiology, and End Results (SEER) database was searched for 8366 patients with colorectal liver cancer metastases (CRLM) from 2010 to 2015. Overall survival (OS) rates were calculated using the Kaplan-Meier curve. After propensity score matching (PSM), predictors were analyzed by logistic regression analysis, and a nomogram was created to predict for survival benefit of PTR using R software. RESULTS After PSM, there were 814 patients in both PTR group and non-PTR group, respectively. The median OS time in the PTR group was 26 months (95%CI = 23.33 ~ 28.67) and the median OS time in the non-PTR group was 15 months (95%CI = 13.36 ~ 16.64). The Cox regression analysis found that PTR was an independent predictive factor (HR = 0.46, 0.41 ~ 0.52) for OS. Additionally, logistic regression was used to study the factors impacting PTR benefit, and the results showed that CEA (P = 0.016), chemotherapy (P < 0.001), N stage (P < 0.001), histological grade (P < 0.001), and lung metastasis (P = 0.001) are independent predictive factors affecting the therapeutic outcome of PTR in patients with CRLM. The developed nomogram displayed good discriminative ability in predicting the beneficial probability of PTR surgery, with the area under the curve (AUC) values of 0.801 in training set and 0.739 in validation set respectively. CONCLUSION We developed a nomogram that predicts the survival benefits of PTR in CRLM patients with relatively high accuracy, and quantifies the predictive factors for PTR-related benefits.
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Affiliation(s)
- Mingming He
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, China
| | - Zhenya Jia
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Lei Hu
- Department of General Surgery, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui, 230001, China.
| | - Huo Wu
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, China.
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Thonhauser R, Poglitsch M, Jonas JP, Dong Y, Tschögl M, Gramberger M, Salem M, Santol J, Brandl I, Klimpfinger M, Vierziger C, Gruenberger T. The Effect of Induction Chemotherapy with VEGF Inhibition on Tumor Response in Synchronously Metastasized Potentially Resectable Colorectal Cancer. Cancers (Basel) 2023; 15:cancers15112900. [PMID: 37296862 DOI: 10.3390/cancers15112900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/13/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023] Open
Abstract
(1) Background: The pathological tumor response of the primary tumor to induction chemotherapy in synchronously metastasized colorectal cancer (mCRC) patients has not been investigated. The aim of this study was to compare patients treated with induction chemotherapy combined with vascular endothelial growth factor (VEGF) or with epidermal growth factor receptor (EGFR) antibodies. (2) Methods: We present a retrospective analysis, where we included 60 consecutive patients with potentially resectable synchronous mCRC who received induction chemotherapy combined with either VEGF or EGFR antibodies. The primary endpoint of this study was the regression of the primary tumor, which was assessed by the application of the histological regression score according to Rödel. The secondary endpoints were recurrence-free survival (RFS) and overall survival (OS). (3) Results: A significantly better pathological response and a longer RFS for patients treated with the VEGF antibody therapy compared to those treated with the EGFR antibodies was demonstrated (p = 0.005 for the primary tumor and log-rank = 0.047 for RFS). The overall survival did not differ. The trial was registered with clinicaltrial.gov, number NCT05172635. (4) Conclusion: Induction chemotherapy combined with a VEGF antibody revealed a better pathological response of the primary tumor, leading to a better RFS compared to that with EGFR therapy; this has clinical relevance in patients with potentially resectable synchronously mCRC.
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Affiliation(s)
- Rebecca Thonhauser
- Department of Surgery, HPB Center, Clinic Favoriten, 1100 Vienna, Austria
| | - Marcus Poglitsch
- Department of Surgery, HPB Center, Clinic Favoriten, 1100 Vienna, Austria
| | - Jan Philipp Jonas
- Department of Surgery, HPB Center, Clinic Favoriten, 1100 Vienna, Austria
| | - Yawen Dong
- Department of Surgery, HPB Center, Clinic Favoriten, 1100 Vienna, Austria
| | - Madita Tschögl
- Department of Surgery, HPB Center, Clinic Favoriten, 1100 Vienna, Austria
| | - Mariel Gramberger
- Department of Surgery, HPB Center, Clinic Favoriten, 1100 Vienna, Austria
| | - Mohamed Salem
- Department of Surgery, HPB Center, Clinic Favoriten, 1100 Vienna, Austria
| | - Jonas Santol
- Department of Surgery, HPB Center, Clinic Favoriten, 1100 Vienna, Austria
| | - Irmgard Brandl
- Institute of Pathology and Bacteriology, Clinic Favoriten, 1100 Vienna, Austria
| | - Martin Klimpfinger
- Institute of Pathology and Bacteriology, Clinic Favoriten, 1100 Vienna, Austria
| | - Constantin Vierziger
- Institute for Diagnostic and Interventional Radiology, Clinic Favoriten, 1100 Vienna, Austria
| | - Thomas Gruenberger
- Department of Surgery, HPB Center, Clinic Favoriten, 1100 Vienna, Austria
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Jiao S, Guan X, Niu H, Ma X, Wang K, Liu E, Zhang W, Wei R, Sun P, Chen Y, Wang X. The tumor characteristics, treatment strategy, and prognosis in colorectal cancer patients with synchronous liver metastasis in China and the USA. Int J Colorectal Dis 2023; 38:140. [PMID: 37219592 DOI: 10.1007/s00384-023-04398-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 05/24/2023]
Abstract
PURPOSE This study performed an analysis of clinicopathological characteristics, surgical treatment strategy, and survival for CRC patients with LM between China and the USA. METHODS The CRC patients with simultaneous LM were identified from the Surveillance, Epidemiology, and End Results (SEER) registry and the Chinese National Cancer Center (CNCC) database from 2010 to 2017. We assessed 3-year cancer-specific survival (CSS) according to surgical treatment strategy and time period. RESULTS Differences in patient age, gender, primary tumor location, tumor grade, tumor histology, and tumor stage were observed between the USA and China. Compared to the USA, a larger proportion of patients in China underwent both primary site resection (PSR) and hepatic resection (HR) (35.1% vs 15.6%, P < 0.001), and fewer patients underwent only PSR in China (29.1% vs 45.1%, P < 0.001). From 2010 to 2017, the proportion of patient who underwent both PSR and HR has increased from 13.9% to 17.4% in the USA and from 25.4% to 39.4% in China. The 3-year CSS were increasing over time in both the USA and China. The 3-year CSS of patients receiving HR and PSR were significantly higher than those receiving only PSR and patients treated with no surgery in the USA and China. There were no significant differences of 3-year CSS between the USA and China after adjustment (P = 0.237). CONCLUSIONS Despite the distinctions of tumor characteristics and surgical strategy in patients with LM between the USA and China, increased adoption of HR has contributed to the profound improvements of survival during recent decade.
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Affiliation(s)
- Shuai Jiao
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xu Guan
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China.
| | - Haitao Niu
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Xiaolong Ma
- Department of Colorectal Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Kaifeng Wang
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Enrui Liu
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Weiyuan Zhang
- Department of Colorectal Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ran Wei
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Peng Sun
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China
| | - Yinggang Chen
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China.
| | - Xishan Wang
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China.
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Rijken A, van de Vlasakker VCJ, Simkens GA, Rovers KP, van Erning FN, Koopman M, Verhoef C, de Wilt JHW, de Hingh IHJT. Primary tumor resection or systemic treatment as palliative treatment for patients with isolated synchronous colorectal cancer peritoneal metastases in a nationwide cohort study. Clin Exp Metastasis 2023:10.1007/s10585-023-10212-y. [PMID: 37209222 DOI: 10.1007/s10585-023-10212-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/15/2023] [Indexed: 05/22/2023]
Abstract
Limited data are available to guide the decision-making process for clinicians and their patients regarding palliative treatment options for patients with isolated synchronous colorectal cancer peritoneal metastases (CRC-PM). Therefore, the aim of this study is to analyze the outcome of the different palliative treatments for these patients. All patients diagnosed with isolated synchronous CRC-PM between 2009 and 2020 (Netherlands Cancer Registry) who underwent palliative treatment were included. Patients who underwent emergency surgery or curative intent treatment were excluded. Patients were categorized into upfront palliative primary tumor resection (with or without additional systemic treatment) or palliative systemic treatment only. Overall survival (OS) was compared between both groups and multivariable cox regression analysis was performed. Of 1031 included patients, 364 (35%) patients underwent primary tumor resection and 667 (65%) patients received systemic treatment only. Sixty-day mortality was 9% in the primary tumor resection group and 5% in the systemic treatment group (P = 0.007). OS was 13.8 months in the primary tumor resection group and 10.3 months in the systemic treatment group (P < 0.001). Multivariable analysis showed that primary tumor resection was associated with improved OS (HR 0.68; 95%CI 0.57-0.81; P < 0.001). Palliative primary tumor resection appeared to be associated with improved survival compared to palliative systemic treatment alone in patients with isolated synchronous CRC-PM despite a higher 60-day mortality. This finding must be interpreted with care as residual bias probably played a significant role. Nevertheless, this option may be considered in the decision-making process by clinicians and their patients.
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Affiliation(s)
- Anouk Rijken
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
| | | | - Geert A Simkens
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Koen P Rovers
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Felice N van Erning
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
| | - Miriam Koopman
- Department of Medical Oncology, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Cornelis Verhoef
- Department of Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Ignace H J T de Hingh
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands.
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands.
- GROW- School for Oncology and Development Biology, Maastricht University, Maastricht, the Netherlands.
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49
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Tebala GD, Di Cintio A, Ricci F, Avenia S, Cirocchi R, Desiderio J, Di Nardo D, Di Saverio S, Gemini A, Ranucci MC, Trastulli S, Cianchi F, Scatizzi M, Catena F. Primary Tumour Treatment in Stage 4 Colorectal Cancer with Unresectable Liver and Lung Metastases and No Peritoneal Carcinomatosis-Current Trends and Attitudes in the Absence of Clear Guidelines. J Clin Med 2023; 12:jcm12103499. [PMID: 37240604 DOI: 10.3390/jcm12103499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/20/2023] [Accepted: 05/14/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND The treatment of the primary tumour in colorectal cancer with unresectable liver and/or lung metastases but no peritoneal carcinomatosis is still a matter of debate. In the absence of clear evidence and guidelines, our survey was aimed at obtaining a snapshot of the current attitudes and the rationales for the choice of offering resection of the primary tumour (RPT) despite the presence of untreatable metastases. METHODS An online survey was administered to medical professionals worldwide. The survey had three sections: (1) demographics of the respondent, (2) case scenarios and (3) general questions. For each respondent, an "elective resection score" and an "emergency resection score" were calculated as a percentage of the times he or she would offer RPT in the elective and in the emergency case scenarios. They were correlated to independent variables such as age, type of affiliation and specific workload. RESULTS Most respondents would offer palliative chemotherapy as the first choice in elective scenarios, while a more aggressive approach with RPT would be reserved for younger patients with good performance status and in emergency situations. Respondents younger than 50 years old and those with a specific workload of fewer than 40 cases of colorectal cancer per year tend to be more conservative. CONCLUSIONS In the absence of clear guidelines and evidence, there is a lack of consensus on the treatment of the primary tumour in case of colon cancer with unresectable liver and/or lung metastases and no peritoneal carcinomatosis. Palliative chemotherapy seems to be the first option, but more consistent evidence is needed to guide this choice.
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Affiliation(s)
| | - Antonio Di Cintio
- Department of Digestive and Emergency Surgery, "S. Maria" Hospital Trust, 05100 Terni, Italy
| | - Francesco Ricci
- Department of Digestive and Emergency Surgery, "S. Maria" Hospital Trust, 05100 Terni, Italy
| | - Stefano Avenia
- Department of Digestive and Emergency Surgery, "S. Maria" Hospital Trust, 05100 Terni, Italy
| | - Roberto Cirocchi
- Department of Digestive and Emergency Surgery, "S. Maria" Hospital Trust, 05100 Terni, Italy
| | - Jacopo Desiderio
- Department of Digestive and Emergency Surgery, "S. Maria" Hospital Trust, 05100 Terni, Italy
| | - Domenico Di Nardo
- Department of Digestive and Emergency Surgery, "S. Maria" Hospital Trust, 05100 Terni, Italy
| | - Salomone Di Saverio
- Department of General Surgery, "Madonna del Soccorso" Hospital, 63074 San Benedetto del Tronto, Italy
| | - Alessandro Gemini
- Department of Digestive and Emergency Surgery, "S. Maria" Hospital Trust, 05100 Terni, Italy
| | - Maria Chiara Ranucci
- Department of Digestive and Emergency Surgery, "S. Maria" Hospital Trust, 05100 Terni, Italy
| | - Stefano Trastulli
- Department of Digestive and Emergency Surgery, "S. Maria" Hospital Trust, 05100 Terni, Italy
| | - Fabio Cianchi
- Department of Digestive Surgery, "Careggi" University Hospital, 50134 Firenze, Italy
| | - Marco Scatizzi
- Department of General Surgery, "S. Maria Annunziata e Serratori" Hospital, 50012 Firenze, Italy
| | - Fausto Catena
- Department of General and Emergency Surgery, "Maurizio Bufalini" Hospital, 47521 Cesena, Italy
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50
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Rudnicki Y, Pery R, Shawki S, Warner S, Cleary SP, Behm KT. A Synchronous Robotic Resection of Colorectal Cancer and Liver Metastases-Our Initial Experience. J Clin Med 2023; 12:jcm12093255. [PMID: 37176695 PMCID: PMC10179539 DOI: 10.3390/jcm12093255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/28/2023] [Accepted: 04/30/2023] [Indexed: 05/15/2023] Open
Abstract
INTRODUCTION Synchronous robotic colorectal and liver resection for metastatic colorectal cancer (mCRC) is gaining popularity. This case series describes our initial institutional experience. METHODS A retrospective study of synchronous robotic colorectal and liver resections for metastatic colorectal cancer (March 2020 to December 2021). RESULTS Eight patients underwent synchronous robotic resections. The median age was 59 (45-72), and the median body mass index was 29 (20-33). Seven received neoadjuvant chemotherapy, and five rectal cancers received neoadjuvant radiotherapy. One patient had a low anterior resection with major hepatectomy, two had low anterior resection with minor hepatectomy, and one had abdominoperineal resection with major hepatectomy. One patient had a left colectomy with minor hepatectomy, and two had right colectomies with minor hepatectomy. We used five robotic 8/12 mm ports in all cases. Extraction incisions were Pfannenstiel in four patients, colostomy site in two patients, one perineal incision, and one supra-umbilical incision. The median estimated blood loss was 200 mL (25-500), and the median operative time was 448 min (374-576). There were no intra-operative complications or conversions. Five patients had the liver resection first, and two of six anastomoses were performed before the liver resection. The Median length of stay was 4 days (3-14). There were two post-operative complications, prolonged ileus and DVT, with a Clavien-Dindo complication grade of I and II, respectively. There were no readmissions or reoperations. All colorectal and liver resection margins were negative. CONCLUSIONS Synchronous robotic colorectal and liver resection can be performed effectively utilizing one port configuration with acceptable short-term outcomes and quality of oncologic resection.
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Affiliation(s)
- Yaron Rudnicki
- Department of Surgery, Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN 55905, USA
- Department of Surgery, Meir Medical Center, Faculty of Medicine, Tel Aviv University, Kfar Saba 4428164, Israel
| | - Ron Pery
- Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, MN 55905, USA
- Department of Surgery and Transplantation, Sheba Medical Center, Faculty of Medicine, Tel Aviv University, Kfar Saba 4428164, Israel
| | - Sherief Shawki
- Department of Surgery, Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Susanne Warner
- Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Sean Patrick Cleary
- Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Kevin T Behm
- Department of Surgery, Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN 55905, USA
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